Stacie Clark, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4301117007 Issued in MI

Practice address

6700 N Rochester Rd Ste 112
Rochester Hills, MI 48306-4378

Phone

(248) 650-1510

NPI assigned

Apr 2, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Internal Medicine

Education

Michigan State University College of Human Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pinnacle Dermatology SCGroup PAC ID 8628353380, 145 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
• Ascension Providence Rochester Hospital Hospital, Rochester, MI, CCN 230254

Merit-based Incentive Payment System (MIPS)

Final score

89.8 of 100Reported as group

Promoting interoperability

88

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stacie.clark@qdp.emadirect.md
• Direct secure messaging: sclark296597@direct.hfhs.org

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.

• Pinnacle Dermatology, SC

  • Dermatology Physician
  • Joliet, IL
  • NPI 1861930984

  MI

  Medicare reassignment Care Compare group
• Audrey Bruell, M.D. P.C.

  • Dermatology Physician
  • Livonia, MI
  • NPI 1306965983
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health Rochester Hospital

  • General Acute Care Hospital
  • Rochester, MI
  • NPI 1437176203
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Troy

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation

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

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578182400000",
    "number": "1558756833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 N ROCHESTER RD STE 112",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483064378",
            "telephone_number": "248-650-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 N ROCHESTER RD STE 112",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483064378",
            "telephone_number": "248-650-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STACIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-02",
        "last_updated": "2020-01-05",
        "certification_date": "2020-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301117007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Rochester Hills
• Abi Clark
• Adalyn L Clark
• Efia Teray Clark, LMT
• Robert Joseph Clark, O.D.
• Emma Marie Claucherty
• Hailie Clawson, MA, LLC, ATR
• Monika Clay, AGPCNP-C
• Christy Clement, LPC
• Click Away LLC

• Dermatology Physician in Rochester Hills, MI
• Providers in Rochester Hills, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.