Michael R Clark, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

035740 Issued in MI

Practice address

1215 E Michigan Ave
Lansing, MI 48912-1811

Phone

(517) 364-2223

NPI assigned

Sep 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Sparrow Ionia Hospital

  • Critical Access Hospital
  • Ionia, MI
  • NPI 1700820065
  Medicare reassignment NPD
• Vituity - Michigan Em PC

  • Emergency Medicine Physician
  • Lansing, MI
  • NPI 1144892332
  Medicare reassignment NPD
• Sparrow Ionia Hospital

  • Family Medicine Physician
  • Ionia, MI
  • NPI 1033271143
  NPD
• Sparrow Ionia Hospital

  • Emergency Medicine Physician
  • Ionia, MI
  • NPI 1588747075
  NPD

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198195200000",
    "number": "1386745446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 634280",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452630041",
            "telephone_number": "517-336-8080",
            "fax_number": "517-336-9122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 E MICHIGAN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121811",
            "telephone_number": "517-364-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2007-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "035740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1253242",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0103325402",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP & PHPFC",
            "identifier": "200000001776",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Helayne Christine Clark
• Jacob Nicholas Clark, PA-C
• Logan Clark, DO
• Marissa Clark, SWT
• Marsha J Clark, M.A., L.L.C.P.
• Robert C Clark, L.P.C.
• Ronald R Clark, CSW
• Samantha Anne Clark, D.O.
• Alicia Clarke, LLMSW
• Nicole A Clarke, MD

• Emergency Medicine Physician in Lansing, MI
• Providers in Lansing, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.