Charlotte Ann Clark, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41455 Issued in MN

Practice address

730 E 2ND St
Apt. 3
Winona, MN 55987-4400

Phone

(507) 454-0903

Fax

(507) 454-0600

NPI assigned

Jul 28, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

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.

• Winona Health Services

  • General Acute Care Hospital
  • Winona, MN
  • NPI 1295789352
  Medicare reassignment NPD

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248739200000",
    "number": "1386875128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 E 2ND ST",
            "address_2": "APT. 3",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559874400",
            "telephone_number": "507-454-0903",
            "fax_number": "507-454-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 E 2ND ST",
            "address_2": "APT. 3",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559874400",
            "telephone_number": "507-454-0903",
            "fax_number": "507-454-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLOTTE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-28",
        "last_updated": "2009-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "41455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Children's Dental of Winona, LLC
• Eric R Christensen, PT
• Juliet Esther Christensen
• David A Christenson, MD
• Christopher E Carroll
• Christine E. Clark, RPH
• Brianna Ahriel Cody
• Lai Loni Timone Colby
• Autumn Leigh Cole, MSN, R.N. FNP-C
• Amanda Coleman

• Family Medicine Physician in Winona, MN
• Providers in Winona, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; 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.