Erin Clark

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

125060391 Issued in IL

Practice address

1900 W Polk St
Chicago, IL 60612-3723

Phone

(312) 864-0060

NPI assigned

Jun 23, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bluewater Emergency Partners of Brunswick, LLCGroup PAC ID 3375774227, 151 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Central Maine Medical Center Hospital, Lewiston, ME, CCN 200024
• Bridgton Hospital Hospital, Bridgton, ME, CCN 201310
• Rumford Hospital Hospital, Rumford, ME, CCN 201306
• Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Bluewater Emergency Partners of Brunswick, LLC

  • Emergency Medicine Physician
  • Brunswick, ME
  • NPI 1043640204
  Medicare reassignment Care Compare group NPD
• South Bend Emergency Physicians, Inc

  • Emergency Medicine Physician
  • South Bend, IN
  • NPI 1487132114
  NPD

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

• Bridgton Hospital

  • Critical Access Hospital
  • Bridgton, ME
  • NPI 1154370153
  Care Compare affiliation
• Central Maine Medical Center

  • General Acute Care Hospital
  • Lewiston, ME
  • NPI 1689653487
  Care Compare affiliation
• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • South Bend, IN
  • NPI 1295772093
  Care Compare affiliation
• Memorial Hospital of South Bend

  • Psychiatric Hospital Unit
  • South Bend, IN
  • NPI 1376841395
  Care Compare affiliation
• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • Granger, IN
  • NPI 1881177756
  Care Compare affiliation
• Rumford Hospital

  • Critical Access Hospital
  • Rumford, ME
  • NPI 1205991122
  Care Compare affiliation

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308787200000",
    "number": "1487940888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 W POLK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 W POLK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123723",
            "telephone_number": "312-864-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ERIN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-23",
        "last_updated": "2011-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125060391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "125060391",
            "identifier": "125060391",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine Clark, PHARMD
• David M Clark, DDS
• David Scott Clark II, PA-C
• Elijah Boone Clark, PA-C
• Emma Elizabeth Clark, MSW, PMH-C
• Hannah D Clark, PHD
• Ingrid Clark, MS, RD, LDN
• Janet O'Hare Clark, P.T.
• Jason Clark
• Jeffrey Clark, MD

• Emergency Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2011; 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.