Stephen David Clark, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

265229 Issued in NY

Practice address

162 E 78TH St FL 1
New York, NY 10075-0406

Phone

(212) 744-1100

Fax

(877) 732-3203

NPI assigned

Jun 29, 2007

Last updated

Dec 11, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 5, 2022 through Jan 5, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• M Shane Dawson MD PLLC

  • Surgery Physician
  • New York, NY
  • NPI 1740755685
  NPD (past)
• One Medical of Ny, P.C.

  dba One Medical Group

  • Family Medicine Physician
  • New York, NY
  • NPI 1861709487

  Internal Medicine

  NPD (past)
• Michael Karagas, M.D., P.C. D/B/a/ KMG Medical Group

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1740788702
  NPD (past)

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1598962847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 SUTTER ST",
            "address_2": "2ND FLOOR",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941044003",
            "telephone_number": "415-658-6791",
            "fax_number": "917-591-6490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 E 78TH ST FL 1",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100750406",
            "telephone_number": "212-744-1100",
            "fax_number": "877-732-3203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHEN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL30146",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "265229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Clark
• Rebecca (Becky) A Clark, PHD, LCSW-R, CC-AASP
• Roger Clark
• Sheryl Diane Clark, MD
• Siobhan Clark, LMSW
• Taylor Rebecca Clark, N.P
• Lovelett Clarke - Palmer, RN
• Clarke School for the Deaf, the (Clarke School-New York)
• Maureen Clarke-Holder, NP
• Kesha Clarke-Lobato, LCSW

• Internal Medicine Physician in New York, NY
• Providers in New York, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.