Active NPI
Laura C Clark, M.D.
- Pediatrics Physician
- Warren, MI
National Provider Identifier
1447360458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- LC063734
- Practice address
- 30061 Schoenherr Rd
Suite a
Warren, MI 48088-3133 - Phone
- (586) 558-2111
- Fax
- (586) 558-2169
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | LC063734 | MI | Primary |
Addresses
Primary practice location
30061 Schoenherr Rd
Suite a
Warren, MI 48088-3133
Mailing address
30061 Schoenherr Rd
Suite a
Warren, MI 48088-3133
Phone (586) 558-2111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3288130 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC063734 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northpointe Pediatrics PC | Past | Accepting new patients | |
| Northpointe Pediatrics, P.C. | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- lclark1121312@direct.hfhs.org
- laura.clark@np1.eclinicaldirectplus.com
Organizations & group practices 2
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.
-
- Non-Pharmacy Dispensing Site
- Warren, MI
- NPI 1730124934
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691452800000",
"number": "1447360458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30061 SCHOENHERR RD",
"address_2": "SUITE A",
"city": "WARREN",
"state": "MI",
"postal_code": "480883133",
"telephone_number": "586-558-2111",
"fax_number": "586-558-2169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30061 SCHOENHERR RD",
"address_2": "SUITE A",
"city": "WARREN",
"state": "MI",
"postal_code": "480883133",
"telephone_number": "586-558-2111",
"fax_number": "586-558-2169"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LAURA",
"middle_name": "C",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2023-08-08",
"certification_date": "2023-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "LC063734",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3288130",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.