NPIMap

Individual provider Active NPI

David A Clark, DO

  • Neurology Physician
  • Springfield, OR
National Provider Identifier
1578760278
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
DO156992 Issued in OR
Practice address
1 Hayden Bridge Way
Springfield, OR 97477-1347
Phone
(541) 868-9430
Fax
(541) 868-9450
NPI assigned
Jun 27, 2007
Last updated
May 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 5101017272 MI
Neurology Physician 2084N0400X DO156992 OR Primary

Addresses

Primary practice location

1 Hayden Bridge Way
Springfield, OR 97477-1347

Mailing address

1 Hayden Bridge Way
Springfield, OR 97477-1347

Other identifiers 1

IdentifierTypeStateIssuer
1578760278MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120724000001 OR Practitioner - Neurology 6406033141 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Michigan State University College of Osteopathic Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Neurology Associates Eugene-Springfield PCGroup PAC ID 0446246888, 9 clinicians

Practice addresses (Care Compare)

1 Hayden Bridge Way
Springfield, OR 97477-1347
Phone (541) 868-9430

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
North Bend Medical Center Inc CurrentSince Sep 24, 2019 Accepting new patients
North Bend Medical Center Inc CurrentSince Sep 24, 2019 Accepting new patients
Neuropsychological Services of Oregon, LLC PastSince Aug 1, 2012 Accepting new patients

Locations

1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151

Interoperability endpoints

  • Direct secure messaging: dclark21@yourcarecommunity.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1578760278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HAYDEN BRIDGE WAY",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771347",
            "fax_number": "541-868-9450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HAYDEN BRIDGE WAY",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771347",
            "telephone_number": "541-868-9430",
            "fax_number": "541-868-9450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAVID",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "5101017272",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "DO156992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578760278",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.