Ted Robert Clark, M.D., M.P.P.
Individual provider Active NPI Emergency Medicine Physician · Springfield, IL
NPI 1497914741 · NPPES record last updated Mar 14, 2013
Key facts
- NPI
- 1497914741
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 01064079A (IN)
- Practice address
- 701 N. 1St Street
Springfield, IL 62781 - Phone
- (217) 545-7409
- Fax
- (217) 545-2711
- NPI assigned
- Jun 3, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Owned or controlled facilities with NPI records 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Memorial Home Hospice |
Hospice | Corporate Director | Jan 1, 2026 |
| Memorial Physician Services |
Rural health clinic | Corporate Officer | Jan 14, 2026 |
| Memorial Physician Services |
Rural health clinic | Corporate Director | Jan 14, 2026 |
| Memorial Physician Services |
Rural health clinic | Corporate Director | Jan 14, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090804000267 | IL | Practitioner - Emergency Medicine | 7618020975 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01064079A | IN | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abraham Lincoln Memorial Hospital | Current |
Accepting new patients | |
| Abraham Lincoln Memorial Hospital | Current |
Accepting new patients | |
| Abraham Lincoln Memorial Hospital | Current |
Accepting new patients | |
| Midwest Emergency Department Specialists LTD | Emergency Medicine | Current |
Accepting new patients |
Locations
2300 N Edward St
Decatur, IL 62526
Phone (217) 876-3000
200 Stahlhut Dr
Lincoln, IL 62656
Phone (217) 605-5611
701 N 1st St
Springfield, IL 62781
Phone (217) 788-3100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 01064079A | IN | Yes |
Addresses
Primary practice location
701 N. 1St Street
Springfield, IL 62781
Mailing address
PO Box 19638
Springfield, IL 62794-9638
Phone (217) 545-7409
Other providers in Springfield, IL
- Andrew Clark
- Connie Lynn Clark
- Kelsey Jo Clark
- Melissa Gayle Clark
- Michelle Marie Clark
- Cathy L. Clausen
- Taylor Paige Clay
- Brittany L. Clayton
- Marsha E. Clayton
- Gregory E Clem
All providers in Springfield, IL · Emergency Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2013. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.