Individual provider Active NPI

Ryan L Clark, D.O.

  • Emergency Medicine Physician
  • Springfield, MA
National Provider Identifier
1699160374
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
273928 Issued in MA
Practice address
759 Chestnut Street
Springfield, MA 01107
Phone
(413) 794-3233
Fax
(413) 794-9060
NPI assigned
Mar 31, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 273928 MA Primary

Addresses

Primary practice location

759 Chestnut Street
Springfield, MA 01107

Mailing address

280 Chestnut Street
2ND Floor
Springfield, MA 01199-1001
Phone (413) 794-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20180508001636 MA Practitioner - Emergency Medicine 0648583302 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Philadelphia College of Osteopathic Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baystate Medical Practices IncGroup PAC ID 5991602971, 1,350 clinicians

Practice addresses (Care Compare)

759 Chestnut St
Springfield, MA 01107-1619
Phone (413) 794-8121

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Baystate Wing Hospital Corporation CurrentSince Apr 26, 2018 Accepting new patients
Baystate Wing Hospital Corporation CurrentSince Apr 26, 2018 Accepting new patients
Baystate Franklin Medical Center CurrentSince Apr 26, 2018 Accepting new patients
Baystate Medical Practices, Inc CurrentSince Apr 26, 2018 Accepting new patients

Locations

164 High St
Greenfield, MA 01301
Phone (413) 772-0211

40 Wright St
Palmer, MA 01069
Phone (413) 284-5210

280 Chestnut St
Fl 2
Springfield, MA 01199
Phone (413) 788-4385

759 Chestnut St
Springfield, MA 01107
Phone (413) 794-6297

759 Chestnut St
Springfield, MA 01199
Phone (413) 794-3233

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1699160374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 CHESTNUT STREET",
            "address_2": "2ND FLOOR",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011991001",
            "telephone_number": "413-794-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "759 CHESTNUT STREET",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "01107",
            "telephone_number": "413-794-3233",
            "fax_number": "413-794-9060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RYAN",
        "middle_name": "L",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-31",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "273928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

Verify at the official NPI Registry.