Derrick Rogers Clark, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

072850 Issued in IA

Practice address

673 Westbury Dr Ste 201
Iowa City, IA 52245-2732

Phone

(319) 356-6352

Fax

(319) 358-2367

NPI assigned

Sep 15, 2010

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

Enrolled in IA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychiatric Associates of Iowa, PCGroup PAC ID 9638550544, 50 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Psychiatric Associates of Iowa, PC

  dba Psychiatric Associates

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • North Liberty, IA
  • NPI 1568121457
  Medicare reassignment Care Compare group NPD (past)
• Psychiatric Associates of Iowa, PC

  dba LifeWorks

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • North Liberty, IA
  • NPI 1720709074
  NPD (past)
• Todd Verhoef, MD P.C.

  dba Psychiatric Associates

  • Psychiatry Physician
  • Iowa City, IA
  • NPI 1013051291
  NPD (past)

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

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1609184324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "673 WESTBURY DR STE 201",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522452732",
            "telephone_number": "319-356-6352",
            "fax_number": "319-358-2367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "673 WESTBURY DR STE 201",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522452732",
            "telephone_number": "319-356-6352",
            "fax_number": "319-358-2367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DERRICK",
        "middle_name": "ROGERS",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-15",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MO",
            "license": "2010031959",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "072850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Michael Clark, PA-C
• Charles R Clark, MD
• Christopher D Clark, M.D.
• Colin Clark, MD
• Connor Clark, PHARMD
• Dewey K. Clark, M.D.
• Eve Dillman Clark, MD
• Janet Marie Clark, MD
• Jennifer Clark, MA, CRC, LMHC
• Jennifer Lynn Clark

• Mental Health Counselor in Iowa City, IA
• Providers in Iowa City, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.