Michael A Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2022033941 Issued in MO

Practice address

327 E Airport Dr
Carthage, MO 64836-3402

Phone

(417) 237-0604

Fax

(417) 237-0613

NPI assigned

Sep 21, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Sgoh Acquisition Inc

  • Clinic/Center
  • Springfield, MO
  • NPI 1114924768
  NPD
• Sgoh Acquisition Inc

  • Rural Health Clinic/Center
  • Decatur, AR
  • NPI 1699513507
  NPD

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

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1639958481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 E AIRPORT DR",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648363402",
            "telephone_number": "417-237-0604",
            "fax_number": "417-237-0613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 E AIRPORT DR",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648363402",
            "telephone_number": "417-237-0604",
            "fax_number": "417-237-0613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-21",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2022033941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carthage Vision Clinic LLC
• Caroline R Charlton
• Elaine G Childs, LPC
• Barbara G. Chilton, DO
• Maria Leneth Erispe Choca, PT
• Ashley Diane Cobb, RD, LD, CDE
• Sarah Cochran, MS
• Complete Quick Care, LLC
• Consultation Services, Inc.
• Jacqueline Corkin, D.C.

• All providers in Carthage, MO
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.