Active NPI
Stephanie Michele Clark, M.D.
- Internal Medicine Physician
- Ann Arbor, MI
National Provider Identifier
1457670184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301102116
- Practice address
- 375 Briarwood Circle
Building 3
Ann Arbor, MI 48108-1605 - Phone
- (734) 998-7207
- Fax
- (734) 998-7100
- NPI assigned
- May 20, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301102116 | MI | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
375 Briarwood Circle
Building 3
Ann Arbor, MI 48108-1605
Mailing address
3621 South State Street
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301102116 | MI | MD | Internal Medicine Physician |
Interoperability endpoints
- sclark@landmarkhealth-direct.org
- sclark401115@direct.med.umich.edu
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366675200000",
"number": "1457670184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 SOUTH STATE STREET",
"address_2": "700 KMS PLACE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48108",
"telephone_number": "734-936-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 BRIARWOOD CIRCLE",
"address_2": "BUILDING 3",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481081605",
"telephone_number": "734-998-7207",
"fax_number": "734-998-7100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "STEPHANIE",
"middle_name": "MICHELE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-20",
"last_updated": "2013-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301102116",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; 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.