Ted Robert Clark, M.D., M.P.P.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

01064079A Issued in IN

Practice address

701 N. 1St Street
Springfield, IL 62781

Phone

(217) 545-7409

Fax

(217) 545-2711

NPI assigned

Jun 3, 2008

Last updated

Mar 14, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Memorial Home Services

  • Community Based Hospice Care Agency
  • Springfield, IL
  • NPI 1003935560

  Corporate Director

  CMS ownership
• Memorial Physician Services

  • Rural Health Clinic/Center
  • Jacksonville, IL
  • NPI 1528741147

  Corporate Director

  CMS ownership
• Memorial Physician Services

  • Rural Health Clinic/Center
  • Lincoln, IL
  • NPI 1568715126

  Corporate Director

  CMS ownership
• Memorial Physician Services

  • Rural Health Clinic/Center
  • Petersburg, IL
  • NPI 1790038099

  Corporate Officer

  CMS ownership

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.

• Abraham Lincoln Memorial Hospital

  • Critical Access Hospital
  • Lincoln, IL
  • NPI 1154329753
  Medicare reassignment NPD
• Abraham Lincoln Memorial Hospital

  • Certified Registered Nurse Anesthetist
  • Lincoln, IL
  • NPI 1558586180
  Medicare reassignment NPD
• Midwest Emergency Department Specialists LTD

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1245263367
  Medicare reassignment NPD
• Abraham Lincoln Memorial Hospital

  • Critical Access Hospital
  • Lincoln, IL
  • NPI 1255304721
  NPD

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363219200000",
    "number": "1497914741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19638",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949638",
            "telephone_number": "217-545-7409",
            "fax_number": "217-545-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N. 1ST STREET",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62781",
            "telephone_number": "217-545-7409",
            "fax_number": "217-545-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TED",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-03",
        "last_updated": "2013-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01064079A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Clark, O.D.
• Connie Lynn Clark, M.S.ED., LCPC
• Kelsey Jo Clark, CRNA
• Melissa Gayle Clark, PA-C
• Michelle Marie Clark, M.S., CCC-SLP
• Cathy L. Clausen, M.D.
• Taylor Paige Clay, AUD
• Brittany L. Clayton, DPT
• Marsha E. Clayton, M.A., L.C.P.C.
• Gregory E Clem, M.D.

• Emergency Medicine Physician in Springfield, IL
• Providers in Springfield, 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 Mar 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.