Matthew Houston Clark MD Inc

Primary specialty

Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X

Legal business name

MATTHEW HOUSTON CLARK MD INC

Doing business as

The Clark Center for Urogynecology

Practice address

520 Superior Ave
Suite 225
Newport Beach, CA 92663-3637

Phone

(949) 360-0300

NPI assigned

Nov 19, 2009

Last updated

Sep 4, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Matthew H. Clark, M.D.NPI 1952417339

Title

Owner

Phone

(949) 360-0300

Specialties & licenses 2

Addresses

Other names 1

• The Clark Center for Urogynecology Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew H Clark, M.D.

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Newport Beach, CA
  • NPI 1952417339
  Medicare reassignment NPD Authorized official
• Carrie Heinemann, PA-C

  • Physician Assistant
  • Newport Beach, CA
  • NPI 1477012474
  Medicare reassignment
• Ana Jimenez, PA-C

  • Physician Assistant
  • Newport Beach, CA
  • NPI 1598909103
  Medicare reassignment

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

{
    "created_epoch": "1258588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1679801229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR AVE",
            "address_2": "SUITE 225",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633637",
            "telephone_number": "949-360-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR AVE",
            "address_2": "SUITE 225",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633637",
            "telephone_number": "949-360-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW HOUSTON CLARK MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-19",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-360-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Clark Center for Urogynecology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.