Active NPI
Elizabeth Talley Clark, M.D., R.V.T.
- Vascular Surgery Physician
- Arlington Heights, IL
National Provider Identifier
1487646535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 036-076927
- Practice address
- 1614 W Central Rd
Suite 100
Arlington Heights, IL 60005-2490 - Phone
- (847) 577-5814
- Fax
- (847) 577-5914
- NPI assigned
- Aug 16, 2005
- Last updated
- Apr 24, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 036-076927 | IL | Primary |
Addresses
Primary practice location
1614 W Central Rd
Suite 100
Arlington Heights, IL 60005-2490
Mailing address
1614 W Central Rd
Suite 100
Arlington Heights, IL 60005-2490
Phone (847) 577-5814
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487646535 | Other | IL | NPI |
| 036-076927-1 | Medicaid | IL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-076927 | IL | MD | Vascular Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illinois Phlebology Associates SC | Vascular Surgery | Past | Accepting new patients |
| Vein Clinics of Chicago LLC | Vascular Surgery | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Vascular Surgery Physician
- Chicago, IL
- NPI 1386904621
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429833600000",
"number": "1487646535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1614 W CENTRAL RD",
"address_2": "SUITE 100",
"city": "ARLINGTON HEIGHTS",
"state": "IL",
"postal_code": "600052490",
"telephone_number": "847-577-5814",
"fax_number": "847-577-5914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1614 W CENTRAL RD",
"address_2": "SUITE 100",
"city": "ARLINGTON HEIGHTS",
"state": "IL",
"postal_code": "600052490",
"telephone_number": "847-577-5814",
"fax_number": "847-577-5914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ELIZABETH",
"middle_name": "TALLEY",
"name_prefix": "Dr.",
"credential": "M.D., R.V.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-16",
"last_updated": "2015-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "IL",
"license": "036-076927",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1487646535",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036-076927-1",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Arlington Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.