Katie Clark Wadlington, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

E-15363 Issued in AR

Practice address

5921 Riley Park Dr
Fort Smith, AR 72916-6103

Phone

(479) 649-3376

NPI assigned

Apr 27, 2018

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

Other names 1

• Katie Clark Former name

Medicare fee-for-service enrollment

Enrolled in GA

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

Dermatology

Education

Louisiana State University School of Medicine in Shreveport, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Specialists of W GaGroup PAC ID 1456397660, 10 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

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.

• Dermatology Specialists of W Ga

  dba Newnan Dermatology

  • Dermatology Physician
  • Carrollton, GA
  • NPI 1780658203
  Medicare reassignment Care Compare group NPD
• West Georgia Derm Surgery Center

  • MOHS-Micrographic Surgery Physician
  • Carrollton, GA
  • NPI 1235065590
  NPD (past)

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

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1417445180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7108 FOREST CANYON DR",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729164078",
            "telephone_number": "318-243-7458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5921 RILEY PARK DR",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729166103",
            "telephone_number": "479-649-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADLINGTON",
        "first_name": "KATIE",
        "middle_name": "CLARK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-27",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AR",
            "license": "E-15363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "CLARK",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Timothy C Waack, MD
• Rachel Waddell, LPTA
• Wyatt Waddell, PTA
• Josh Wade, PTA
• Moorea Wade, QBHP
• Donnelle I. Wagner, DNP
• Micaiah Wagner, DPT
• Shane L Wagner, MHPP
• Andrea Waguespack
• Lauren Paige Wahlmeier, PA-C

• Dermatology Physician in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Dermatology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; 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.