Kirby P Clark, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

35956 Issued in IA

Practice address

4006 Johnathan St
Waterloo, IA 50701-9387

Phone

(319) 236-2700

NPI assigned

Jun 2, 2006

Last updated

Nov 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, IA, IL3 enrollments

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 3

Specialty

Diagnostic Radiology

Education

University of Michigan Medical School, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cedar Valley Medical Specialists PCGroup PAC ID 1759291487, 61 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cedar Valley Medical Specialists PC

  • Orthopaedic Surgery Physician
  • Waterloo, IA
  • NPI 1497794242

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• Peoples Community Health Clinic, Inc

  dba Success Street-West High School

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IA
  • NPI 1629684709
  Medicare reassignment NPD
• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314

  Diagnostic Radiology

  Medicare reassignment NPD
• Prairie Du Chien Memorial Hospital Association Inc

  dba Crossing Rivers Health

  • Critical Access Hospital
  • Prairie Du Chien, WI
  • NPI 1619024197
  Medicare reassignment NPD
• Cedar Valley Medical Specialists PC

  • Durable Medical Equipment & Medical Supplies
  • Vinton, IA
  • NPI 1659934180
  NPD
• Peoples Community Health Clinic, Inc

  dba Peoples Clinic Clarksville School

  • Federally Qualified Health Center (FQHC)
  • Clarksville, IA
  • NPI 1336850734
  NPD
• Peoples Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IA
  • NPI 1093703639
  NPD
• Marshfield Clinic Inc

  dba Marshfield Clinic Florida Teleradiology/Telehealth

  • Clinic/Center
  • Marshfield, WI
  • NPI 1952347981
  NPD
• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• Prairie Du Chien Memorial Hospital Assoc Inc

  dba Crossing Rivers Health Clinic

  • Family Medicine Physician
  • Prairie Du Chien, WI
  • NPI 1659709830
  NPD
• Gundersen Clinic LTD

  • Clinic/Center
  • La Crosse, WI
  • NPI 1851343115
  NPD (past)

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700524800000",
    "number": "1407893795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2758",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507042758",
            "telephone_number": "319-235-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4006 JOHNATHAN ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507019387",
            "telephone_number": "319-236-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "660 N Westmoreland Rd",
            "address_purpose": "LOCATION",
            "city": "Lake Forest",
            "state": "IL",
            "postal_code": "600451659",
            "country_code": "US",
            "telephone_number": "847-535-7480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIRBY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "35956",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "42049-20",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036126457",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City Builders and Supplies (City Builders)
• City of Waterloo (Waterloo Fire Rescue)
• Clark and Associates, Inc
• Grant William Clark
• Jessica Nicole Clark, NP-C
• Melissa Clark, ARNP
• Christopher Edmund Clayton, PHARMD
• Jennifer Leigh Clayton, PHARMD
• Webster N Clayton, MD
• Kristi M Clements, LISW

• Diagnostic Radiology Physician in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Diagnostic Radiology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; 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.