Mitchell Brent Clark, MD
Individual provider Active NPI Gynecologic Oncology Physician · New Haven, CT
NPI 1669817854 · NPPES record last updated Apr 9, 2020
Key facts
- NPI
- 1669817854
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gynecologic Oncology Physician 207VX0201X
- License
- 65152 (CT)
- Practice address
- 333 Cedar St.
Yale Medical School
New Haven, CT 06510 - Phone
- (203) 833-0281
- NPI assigned
- May 2, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 13
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Gynecological Oncology
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Stamford Health Medical Group Inc
Yale University
Practice addresses (Care Compare)
1 Hospital PLZ
Stamford, CT 06902-3602
Phone (203) 276-1000
20 York St
New Haven, CT 06510-3220
Phone (203) 785-4638
Hospital & facility affiliations
- Bridgeport Hospital
- Stamford Hospital
- Yale-New Haven Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.6 of 100
- Quality
- 84.86
- Promoting interoperability
- 99
- Improvement activities
- 40
- Cost
- 71.31
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.36 of 100
- Quality
- 77.36
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.27
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of the uterus | 12 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200916002622 | CT | Practitioner - Gynecological Oncology | 6002234473 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65152 | CT | MD | Gynecologic Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yale University | Current |
Accepting new patients | |
| Stamford Health Medical Group Inc | Single Specialty | Current |
Accepting new patients |
| Yale University | Single Specialty | Current |
Accepting new patients |
Locations
267 Grant St
Bridgeport, CT 06610
Phone (203) 384-3170
333 Cedar St
New Haven, CT 06510
Phone (203) 432-4771
800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140
50 Division St
New Haven, CT 06511
Phone (203) 785-2140
20 York St
North Haven, CT 06510
Phone (203) 688-2433
5 High Ridge Park
Ste 103
Stamford, CT 06905
Phone (203) 276-4644
1 Hospital Plz
Stamford, CT 06902
Phone (203) 276-4925
Interoperability endpoints
- mclark24655@stamfordhealth.direct-ci.com
- mclark120071@direct.ynhh.org
- https://fhir4.healow.com/fhir/r4/ABCIBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Gynecologic Oncology Physician |
207VX0201X | 65152 | CT | Yes |
Addresses
Primary practice location
333 Cedar St.
Yale Medical School
New Haven, CT 06510
Mailing address
333 Cedar St.
Yale Medical School
New Haven, CT 06510
Other practice location 1
267 Grant St.
Bridgeport, CT 06610
Phone (203) 384-3990
Other providers in New Haven, CT
- Brian Joseph Clark
- Corinna Augusta Clark
- Genese Calloway Clark
- Helena Jeanette Clark
- Katherine Arlene Arner Clark
- Terri Patrice Clark
- Vashti Clark
- Alicia Clarke
- Ashely Clarke
- C.Vanessa Clarke
All providers in New Haven, CT · Gynecologic Oncology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.