Camm D. Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L6545 Issued in OR

Practice address

149 W. 12TH Avenue
Eugene, OR 97401-6215

Phone

(541) 762-4400

Fax

(541) 344-0772

NPI assigned

Apr 16, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Medical Homes, LLCGroup PAC ID 0042100372, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23944/brand/1/csg/1/fhir/r4

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.

• Northwest Medical Homes, LLC

  • Family Medicine Physician
  • Springfield, OR
  • NPI 1114974946
  Medicare reassignment Care Compare group NPD
• Applegate Medical Associates

  • Clinic/Center
  • Eugene, OR
  • NPI 1417035031
  Medicare reassignment NPD
• Options Counseling Services of Oregon

  • Mental Health Counselor
  • Eugene, OR
  • NPI 1548275217
  Medicare reassignment NPD
• Northwest Medical Homes, LLC

  • Family Medicine Physician
  • Eugene, OR
  • NPI 1174053094
  NPD
• Inner Room Somatic Therapy, LLC

  • Professional Counselor
  • Eugene, OR
  • NPI 1073241030
  NPD (past)

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

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447804800000",
    "number": "1699118935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "687 CHESHIRE AVENUE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974025060",
            "telephone_number": "541-762-4400",
            "fax_number": "541-344-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 W. 12TH AVENUE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974016215",
            "telephone_number": "541-762-4400",
            "fax_number": "541-344-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CAMM",
        "middle_name": "D.",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-16",
        "last_updated": "2015-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": "A3225",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "L6545",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Forrester Clancey, AU.D
• Adam William Clark, PTA
• April Shannon Clark, LPC-ASSOCIATE R7809
• Breanne Ariel Clark
• Caitlin Alexandra Clark, BA, CADC I
• Christina Clark
• Crystal L Clark, RC
• Eric Franklin Clark
• Georganne M. Clark, C.P.M.
• Harold Ulice Clark, ADDICTIONS THERAPIST

• Clinical Social Worker in Eugene, OR
• Providers in Eugene, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.