Active NPI
Brianne Clark, D.O.
- Family Medicine Physician
- Ashland, KS
National Provider Identifier
1497980254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 05-35880
- Practice address
- 709 W Oak
Ashland, KS 67831 - Phone
- (620) 635-2241
- NPI assigned
- May 22, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 05-35880 | KS | Primary |
| Family Medicine Physician | 207Q00000X | 4889 | OK |
Addresses
Primary practice location
709 W Oak
Ashland, KS 67831
Mailing address
PO Box 188
Ashland, KS 67831-0188
Phone (620) 635-2241
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200294890A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171020001587 | KS | Practitioner - Family Practice | 4688821085 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4889 | OK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harper County Community Hospital | Past | Accepting new patients | |
| Harper County Community Hospital | Past | Accepting new patients |
Interoperability endpoints
- brianne.clark@402365878566916.direct.elationemr.com
Organizations & group practices 4
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.
-
- Rural Acute Care Hospital
- Buffalo, OK
- NPI 1134128499
-
- Clinic/Center
- Buffalo, OK
- NPI 1801023890
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400544000000",
"number": "1497980254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 188",
"city": "ASHLAND",
"state": "KS",
"postal_code": "678310188",
"telephone_number": "620-635-2241",
"fax_number": "620-635-4481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 W OAK",
"city": "ASHLAND",
"state": "KS",
"postal_code": "67831",
"telephone_number": "620-635-2241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BRIANNE",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-22",
"last_updated": "2014-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KS",
"license": "05-35880",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "4889",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200294890A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ashland, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.