Active NPI
Molly Patricia Clark, RD
- Registered Dietitian
- San Leandro, CA
National Provider Identifier
1508814666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI00001478
- Practice address
- 2500 Merced St
San Leandro, CA 94577-4201 - Phone
- (510) 454-1000
- NPI assigned
- May 4, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DI00001478 | WA | Primary |
Addresses
Primary practice location
2500 Merced St
San Leandro, CA 94577-4201
Mailing address
2500 Merced St
San Leandro, CA 94577-4201
Phone (510) 454-1000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8369571 | Medicaid | WA | |
| 0172923 | Other | WA | L&I PIN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI00001478 | WA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641168000000",
"number": "1508814666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 MERCED ST",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774201",
"telephone_number": "510-454-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 MERCED ST",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774201",
"telephone_number": "510-454-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MOLLY",
"middle_name": "PATRICIA",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-04",
"last_updated": "2022-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI00001478",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8369571",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I PIN",
"identifier": "0172923",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "The Permanente Medical Group",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "2500 Merced St",
"city": "San Leandro",
"state": "CA",
"country_code": "US",
"postal_code": "945774201",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.