Robert Leon Clark, MD

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

MD 00030055 Issued in WA

Practice address

17058 SE 58TH St
Bellevue, WA 98006-5595

Phone

(206) 790-2397

Fax

(425) 641-4827

NPI assigned

Sep 9, 2005

Last updated

Sep 28, 2016By 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 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in ID

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

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.

• Internal Medicine Associates, P.a.

  • Internal Medicine Physician
  • Sandpoint, ID
  • NPI 1154361988
  Medicare reassignment NPD
• Northwest Critical Care Physicians, P.S.

  • Specialist
  • Tukwila, WA
  • NPI 1871540476
  Authorized official Same address or phone
• Bonner General Hospital Inc.

  dba Bonner General Health

  • Critical Access Hospital
  • Sandpoint, ID
  • NPI 1154563963
  NPD
• Lakeshore Health PLLC

  • Internal Medicine Physician
  • Sandpoint, ID
  • NPI 1487380655
  NPD (past)

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475020800000",
    "number": "1508850181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17058 SE 58TH ST",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980065595",
            "telephone_number": "206-790-2397",
            "fax_number": "425-641-4827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17058 SE 58TH ST",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980065595",
            "telephone_number": "206-790-2397",
            "fax_number": "425-641-4827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROBERT",
        "middle_name": "LEON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2016-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WA",
            "license": "MD 00030055",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WA",
            "license": "MD 00030055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01365435",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508850181",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "810000222",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "38110",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Eric Clark, M.D.
• Kaeli Ann Clark, CDP
• Mark Eldon Clark
• Michael Clark, OTR/L
• Nancy L Clark, PA-C
• Shauna Clark, RN
• Vanessa Christina Clark, PA
• Clark's Pharmacy Inc
• Megan Clarke, MA, LMFTA
• Margaret Clarkson

• Pulmonary Disease Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Pulmonary Disease Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; 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.

Verify at the official NPI Registry.