Christopher William Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10002612A Issued in IN

Practice address

701 E County Line Rd Ste 101
Greenwood, IN 46143-1070

Phone

(317) 885-2860

Fax

(317) 885-2869

NPI assigned

Sep 7, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Indiana Medical College, School of Medicine of Purdue University, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Francis Medical Group LLCGroup PAC ID 7012067697, 113 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Franciscan Health Indianapolis Hospital, Indianapolis, IN, CCN 150162

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cclark546093@ecommunitydirect.com
• Direct secure messaging: cclark407527@direct.franciscanalliance.org
• Direct secure messaging: direct.indianainternalmedicine@ccme.com

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.

• St. Francis Medical Group, LLC

  • Internal Medicine Physician
  • Greenwood, IN
  • NPI 1467693135
  Medicare reassignment Care Compare group NPD
• Community Physicians of Indiana Inc

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1619105244
  Medicare reassignment NPD
• Indiana Internal Medicine Consultants, LLC.

  • Internal Medicine Physician
  • Greenwood, IN
  • NPI 1609834357
  Medicare reassignment
• St Francis Medical Group LLC

  • Internal Medicine Physician
  • Monroe, LA
  • NPI 1134405087
  NPD

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

• Franciscan Health Indianapolis & Mooresville

  • General Acute Care Hospital
  • Carmel, IN
  • NPI 1376214981
  Care Compare affiliation
• Franciscan Health Indianapolis & Mooresville

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1386749893
  Care Compare affiliation

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

{
    "created_epoch": "1536278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1477036291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E COUNTY LINE RD STE 101",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431070",
            "telephone_number": "317-885-2860",
            "fax_number": "317-885-2869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E COUNTY LINE RD STE 101",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431070",
            "telephone_number": "317-885-2860",
            "fax_number": "317-885-2869"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1402 E County Line Rd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462771070",
            "country_code": "US",
            "telephone_number": "317-887-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHRISTOPHER",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-07",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002612A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300020884",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct.indianainternalmedicine@ccme.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "701 E County Line Rd Ste 101",
            "city": "Greenwood",
            "state": "IN",
            "country_code": "US",
            "postal_code": "461431070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephen Christner, LMHC
• Blake Christy, DO
• Olivia Chubb
• Kyle B Ciresi, MSW, LCSW, LCAC
• Donna Cisco, LCSW, LCAC
• Diana L Clark, M.D.
• Haley R Clark
• Jasmine Clark, RBT
• Jordan Lee Clark, PHARMD
• Kelly Lynn Clark, PT

• Physician Assistant in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.