Michael Clark, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

10841920-9934 Issued in UT

Practice address

990 Medical Dr Ste G3
Brigham City, UT 84302

Phone

(435) 374-2097

NPI assigned

Apr 16, 2018

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

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Promontory Vision PartnersGroup PAC ID 3375602790, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.62 of 100Reported as group

Quality

100

Improvement activities

40

Cost

72.06

Medicare enrollment (NPD)

Enrolled

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.

• Promontory Vision Partners

  • Optometrist
  • Clinton, UT
  • NPI 1013187822
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528070400000",
    "number": "1558858464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 MEDICAL DR STE G3",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "843023077",
            "telephone_number": "435-374-2097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 MEDICAL DR STE G3",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "84302",
            "telephone_number": "435-374-2097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2850 N 2000 W Ste 202",
            "address_purpose": "LOCATION",
            "city": "Farr West",
            "state": "UT",
            "postal_code": "844049230",
            "country_code": "US",
            "telephone_number": "801-731-6326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAEL",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "UT",
            "license": "10841920-9934",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "10841920-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carson Christensen
• Kadin Christensen
• Louis Ray Christensen, DDS
• Schryver Lee Christian I
• Hunter Christiansen
• Kevin Clayburn
• Jeffrey Jordan Clifford
• Lindsay Jo Cole
• Jordan Douglas Colledge
• Theodore B Collins, CMHC

• Optometrist in Brigham City, UT
• Providers in Brigham City, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; 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.