NPIMap

Organization Active NPI

Stephen J. Clark M.D.,P.C.

  • Primary Care Clinic/Center
  • Lindenhurst, IL
National Provider Identifier
1487772208
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
STEPHEN J. CLARK M.D.,P.C.
Practice address
3021 Falling Waters Blvd
Suite a
Lindenhurst, IL 60046-6793
Phone
(847) 356-9300
Fax
(847) 356-7260
NPI assigned
Mar 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Stephen J. Clark, MDNPI 1538123385
Title
President
Phone
(847) 356-9300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X IL Primary

Addresses

Primary practice location

3021 Falling Waters Blvd
Suite a
Lindenhurst, IL 60046-6793

Mailing address

3021 Falling Waters Blvd
Suite a
Lindenhurst, IL 60046-6793
Phone (847) 356-9300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050322000781 IL Part B Supplier - Clinic/Group Practice 2466408554 Receives reassigned benefits from 5 practitioners
Practice locations: Lindenhurst, IL

National Provider Directory

National Provider Directory

Locations

3098 Falling Waters Blvd
#100
Lindenhurst, IL 60046
Phone (847) 356-9300

3021 Falling Waters Blvd
Lindenhurst, IL 60046
Phone (847) 234-4310

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487772208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 FALLING WATERS BLVD",
            "address_2": "SUITE A",
            "city": "LINDENHURST",
            "state": "IL",
            "postal_code": "600466793",
            "telephone_number": "847-356-9300",
            "fax_number": "847-356-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 FALLING WATERS BLVD",
            "address_2": "SUITE A",
            "city": "LINDENHURST",
            "state": "IL",
            "postal_code": "600466793",
            "telephone_number": "847-356-9300",
            "fax_number": "847-356-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN J. CLARK M.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-356-9300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lindenhurst, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.