Individual provider Active NPI

Carolyn J Clarick, MD

  • Internal Medicine Physician
  • Mount Kisco, NY
National Provider Identifier
1467408534
Registry record updated Nov 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
218697 Issued in NY
Practice address
Mount Kisco Medical Group PC
90 South Bedford Road
Mount Kisco, NY 10549-3412
Phone
(914) 241-1050
Fax
(914) 242-1516
NPI assigned
May 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 218697 NY Primary

Addresses

Primary practice location

Mount Kisco Medical Group PC
90 South Bedford Road
Mount Kisco, NY 10549-3412

Mailing address

Mount Kisco Medical Group PC
90 South Bedford Rd
Mount Kisco, NY 10549-3412
Phone (914) 241-1050

Other identifiers 3

IdentifierTypeStateIssuer
110213587OtherNYMEDICARE RAILROAD
02109653MedicaidNY
0667910001OtherNYDME

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)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258588800000",
    "number": "1467408534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MOUNT KISCO MEDICAL GROUP PC",
            "address_2": "90 SOUTH BEDFORD RD",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105493412",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MOUNT KISCO MEDICAL GROUP PC",
            "address_2": "90 SOUTH BEDFORD ROAD",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105493412",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARICK",
        "first_name": "CAROLYN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-26",
        "last_updated": "2009-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "218697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "110213587",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02109653",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0667910001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Kisco, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.