Susan M Clack, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD14435 Issued in OR

Practice address

13200 SW Pacific Hwy
Tigard, OR 97223-4828

Phone

(503) 598-2000

Fax

(503) 639-0920

NPI assigned

May 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sclack@pacificmedicalgroup.directbygreenway.com

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.

• Praxis Health, PC

  • Multi-Specialty Clinic/Center
  • Bend, OR
  • NPI 1821068164

  Family Medicine

  Medicare reassignment NPD
• Praxis Health, PC

  • Rural Health Clinic/Center
  • Dallas, OR
  • NPI 1942925326
  NPD

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1669424917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1517",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010410",
            "telephone_number": "877-708-1119",
            "fax_number": "541-278-8349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13200 SW PACIFIC HWY",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972234828",
            "telephone_number": "503-598-2000",
            "fax_number": "503-639-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLACK",
        "first_name": "SUSAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD14435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142307",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR PIN",
            "identifier": "08118136",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittani Chung
• Chyril Walker PHD PC
• Brent Cichoski, M.A.
• Melissa M Cisneros
• Kristin Suzanne Ciula, RN/BSN
• Clark Oral Surgery and Implant Center
• Blythe Patricia Clark-McKitrick
• Adry Snorradottir Clark, PHD
• Alice Halsey Clark, RN
• Ashley Rose Clark

• Family Medicine Physician in Tigard, OR
• Providers in Tigard, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; 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.