Lyle Arthur Clark, M.D.
Individual provider Active NPI Psychiatry Physician · Hannibal, MO
NPI 1477572097 · NPPES record last updated Jun 4, 2014
Key facts
- NPI
- 1477572097
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- R8E55 (MO)
- Practice address
- 141 Communication Drive
Hannibal, MO 63401 - Phone
- (573) 795-7342
- Fax
- (573) 248-3080
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091007000542 | MO | Practitioner - Psychiatry | 7618013541 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark Twain Association for Mental Health, Inc. | Current |
Accepting new patients | |
| Mark Twain Association for Mental Health, Inc | Current |
Accepting new patients | |
| Comprehensive Health Systems, Inc | Past | Accepting new patients | |
| Hannibal Regional Healthcare System Inc | Past | Accepting new patients |
Locations
154 Forrest Dr
Hannibal, MO 63401
Phone (573) 221-2120
Interoperability endpoints
- https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | R8E55 | MO | Yes |
Addresses
Primary practice location
141 Communication Drive
Hannibal, MO 63401
Mailing address
900 E la Harpe St
Kirksville, MO 63501-4520
Phone (660) 665-1962
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 208444604 | Medicaid | MO |
Other providers in Hannibal, MO
- Charles W Janes DDS PC
- Chicago Hearing LLC
- Robin K Christal
- Beverly Ann Christy
- Jill Marie Clark
- Lyreva J Clark
- Edward A Cline
- Jane A Cline
- Steven N. Cockrell
- Savannah J Coelho
All providers in Hannibal, MO · Psychiatry Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.