NPIMap

Individual provider Active NPI

Keith Fredrick Clark, MD PHD

  • Otolaryngology Physician
  • Oklahoma City, OK
National Provider Identifier
1376506642
Registry record updated Oct 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
14220 Issued in OK
Practice address
535 NW 9TH St
Suite 300
Oklahoma City, OK 73102-1070
Phone
(405) 272-6027
Fax
(405) 272-8315
NPI assigned
Apr 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 14220 OK Primary

Addresses

Primary practice location

535 NW 9TH St
Suite 300
Oklahoma City, OK 73102-1070

Mailing address

535 NW 9TH St
Suite 300
Oklahoma City, OK 73102-1070
Phone (405) 272-6027

Other identifiers 6

IdentifierTypeStateIssuer
157107001MedicaidAR
731461178005OtherTRICARE
A0209ZOtherPPO OKLAHOMA
100823600BMedicaidOK
2994975OtherAETNA US HEALTHCARE
P00075512OtherRR MEDICARE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kclark37234@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120302000522 OK Practitioner - Otolaryngology 6204985641 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Michigan Medical School, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

1000 N Lee Ave
Oklahoma City, OK 73102-1036
Phone (405) 272-7000

2749 Progressive Dr
Edmond, OK 73034-7649
Phone (405) 772-4130

608 NW 9TH St
Oklahoma City, OK 73102-1049

Hospital & facility affiliations

  • SSM Health St Anthony Hospital - Oklahoma City Hospital, Oklahoma City, OK, CCN 370037
  • SSM Health St Anthony Hospital - Midwest Hospital, Midwest City, OK, CCN 370094
  • SSM Health St Anthony Hospital - Shawnee Hospital, Shawnee, OK, CCN 370149
  • O U Medical Center Hospital, Oklahoma City, OK, CCN 370093

Merit-based Incentive Payment System (MIPS)

Final score
85.96 of 100Reported as group
Quality
80.43
Promoting interoperability
100
Improvement activities
40
Cost
72.76

Merit-based Incentive Payment System (MIPS)

Final score
70.05 of 100Reported as group
Quality
52.07
Promoting interoperability
100
Improvement activities
40
Cost
48.1

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
14220OKMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saints Medical Group, LLC CurrentSince Apr 1, 2017 Accepting new patients
Saints Medical Group, LLC CurrentSince Apr 1, 2017 Accepting new patients
Oklahoma City Ear, Nose & Throat Clinic, PC Otolaryngology Current Accepting new patients
Centennial Health, PC PastSince May 1, 1992 Accepting new patients
Summit Medical Center Past Accepting new patients
National Family Medical Associates, LLC PastSince Feb 1, 2023 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
SSM Health Care of Oklahoma, Inc. Past Accepting new patients

Locations

608 NW 9th St
Ste 5100
Oklahoma City, OK 73102
Phone (405) 272-6027

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

535 NW 9th St
Ste 300
Oklahoma City, OK 73102
Phone (405) 272-6027

Interoperability endpoints

  • Direct secure messaging: kclark37234@direct-ehr-ssmhc.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602979200000",
    "number": "1376506642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 NW 9TH ST",
            "address_2": "SUITE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731021070",
            "telephone_number": "405-272-6027",
            "fax_number": "405-272-8315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 NW 9TH ST",
            "address_2": "SUITE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731021070",
            "telephone_number": "405-272-6027",
            "fax_number": "405-272-8315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KEITH",
        "middle_name": "FREDRICK",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-08",
        "last_updated": "2020-10-18",
        "certification_date": "2020-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OK",
            "license": "14220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157107001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "731461178005",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPO OKLAHOMA",
            "identifier": "A0209Z",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100823600B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "2994975",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00075512",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kclark37234@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kclark37234@direct-ehr-ssmhc.com",
            "address_1": "535 NW 9th St",
            "address_2": "Suite 300",
            "city": "Oklahoma City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731021070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "535 NW 9th St",
            "address_2": "Suite 300",
            "city": "Oklahoma City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731021070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.