Samantha Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.018675 Issued in IL

Practice address

3117 1St Ave SE Ste a
Cedar Rapids, IA 52402-4403

Phone

(319) 961-2609

Fax

(319) 365-0899

NPI assigned

Dec 23, 2015

Last updated

Aug 25, 2023By the provider in NPPES

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

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Danville Vamc

  • Department of Veterans Affairs (VA) Pharmacy
  • Peoria, IL
  • NPI 1336197284
  NPD (past)

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

{
    "created_epoch": "1450828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1689039257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7717 N ORANGE PRAIRIE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159323",
            "telephone_number": "309-589-6800",
            "fax_number": "309-589-6973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3117 1ST AVE SE STE A",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524024403",
            "telephone_number": "319-961-2609",
            "fax_number": "319-365-0899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SAMANTHA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-23",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.018675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elias Gerrit Clark
• Elizabeth Jazz Clark, TLMHC
• Haley Clark
• Katie Lynn Clark, ARNP
• Ryan Christopher Clark, PHARMD
• Sara Lee Clark, CCC-A
• Clark's Pharmacy, Inc (Clark's Pharmacy)
• Clark's Pharmacy, Inc
• Clarks Medical Services LLC
• Brittany Clary, BA

• Clinical Social Worker in Cedar Rapids, IA
• Providers in Cedar Rapids, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.