Individual provider Active NPI

Scott Menard, MD

  • Adult Medicine Physician
  • Mount Dora, FL
National Provider Identifier
1417579244
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
ACN1340 Issued in FL
Practice address
4601 North, FL-19
Mount Dora, FL 32757
Phone
(239) 245-1698
NPI assigned
May 14, 2020
Last updated
May 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X ACN1340 FL Primary

Addresses

Primary practice location

4601 North, FL-19
Mount Dora, FL 32757

Mailing address

7518 Home Stretch Dr
Wellington, CO 80549-3282
Phone (239) 245-1698

Other practice location 1

7518 Home Stretch Dr
Wellington, CO 80549-3282
Phone (239) 245-1698

Other practice location 2

630 N Bumby Ave
Orlando, FL 32803-4923
Phone (239) 245-1698

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20200831002874 FL Practitioner - General Practice 2567888944 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lowell F. Clark MD PAGroup PAC ID 7416918370, 31 clinicians

Practice addresses (Care Compare)

212 S Florida St
Bushnell, FL 33513-6703
Phone (352) 793-2441

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ACN1340FLMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alina Community Center at Mount Dora LLC CurrentSince May 1, 2021 Accepting new patients
Alina Community Center at Mount Dora LLC CurrentSince May 1, 2021 Accepting new patients
Clark Clinic Inc Past Accepting new patients

Locations

4601 N Highway 19A
Ste B
Mount Dora, FL 32757
Phone (352) 602-7924

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1417579244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7518 HOME STRETCH DR",
            "city": "WELLINGTON",
            "state": "CO",
            "postal_code": "805493282",
            "telephone_number": "239-245-1698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 NORTH, FL-19",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "32757",
            "telephone_number": "239-245-1698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7518 Home Stretch Dr",
            "address_purpose": "LOCATION",
            "city": "Wellington",
            "state": "CO",
            "postal_code": "805493282",
            "country_code": "US",
            "telephone_number": "239-245-1698",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "630 N Bumby Ave",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328034923",
            "country_code": "US",
            "telephone_number": "239-245-1698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENARD",
        "first_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-14",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "FL",
            "license": "ACN1340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Dora, FL

Sources for this page

Verify at the official NPI Registry.