Stevan Ray Clark, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G63102 Issued in CA

Practice address

10220 S Western Ave
Los Angeles, CA 90047-4258

Phone

(323) 757-1744

Fax

(323) 757-3818

NPI assigned

Nov 16, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General SurgeryAlso: General Practice

Education

University of California, Geffen School of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centinela Hospital Medical Center Hospital, Inglewood, CA, CCN 050739
• Memorial Hospital of Gardena Hospital, Gardena, CA, CCN 050468
• Coast Plaza Hospital Hospital, Norwalk, CA, CCN 050771

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

• Gardena Hospital LP

  dba Memorial Hospital of Gardena Pharmacy

  • Institutional Pharmacy
  • Gardena, CA
  • NPI 1669491700
  NPD (past)
• Prime Healthcare Centinela, LLC

  dba Centinela Hospital Medical Center

  • General Acute Care Hospital
  • Inglewood, CA
  • NPI 1336328244
  NPD (past)
• St Francis Medical Center

  • Long Term Care Hospital
  • Lynwood, CA
  • NPI 1346378270
  NPD (past)

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

• CPH Hospital Management LLC

  dba Coast Plaza Hospital

  • General Acute Care Hospital
  • Norwalk, CA
  • NPI 1194016923
  Care Compare affiliation
• CPH Hospital Management LLC

  dba Coast Plaza Hospital

  • Psychiatric Hospital Unit
  • Norwalk, CA
  • NPI 1952012379
  Care Compare affiliation
• Gardena Hospital LP

  dba Memorial Hospital of Gardena

  • General Acute Care Hospital
  • Gardena, CA
  • NPI 1063412005
  Care Compare affiliation
• Prime Healthcare Centinela, LLC

  dba Centinela Hospital Medical Center

  • General Acute Care Hospital
  • Inglewood, CA
  • NPI 1336328244
  Care Compare affiliation

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376616227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10220 S WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900474258",
            "telephone_number": "323-757-1744",
            "fax_number": "323-757-3818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10220 S WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900474258",
            "telephone_number": "323-757-1744",
            "fax_number": "323-757-3818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEVAN",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G63102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G631020",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Clark, MFT
• Richard Alexander Clark
• Richard Wayne Clark, M.D.
• Sayda Vanessa Clark, MSW
• Stephen Clark
• Tiffany Tenise Clark
• Tracy Clark Jr.
• William Deangelo Clark
• Britney Shamay Clarke
• Cristina Edith Clarke, M.S

• Specialist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.