Adam Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L8122 Issued in OR

Practice address

790 E 5TH St
Coquille, OR 97423-1755

Phone

(541) 396-3111

NPI assigned

Feb 28, 2018

Last updated

Sep 3, 2020By the provider in NPPES

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

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, 2014

Medicare assignment

May accept Medicare assignment

Group practices

Waterfall Clinic IncorporatedGroup PAC ID 5698740355, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Waterfall Clinic Incorporated

  dba Waterfall Community Health Center

  • Federally Qualified Health Center (FQHC)
  • North Bend, OR
  • NPI 1619915113
  Medicare reassignment Care Compare group NPD
• Vista Counseling & Consultation, Inc.

  • Community/Behavioral Health Agency
  • Eugene, OR
  • NPI 1275864985
  Medicare reassignment NPD
• Lumira Behavioral Health, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Coos Bay, OR
  • NPI 1487594198

  Clinical

  NPD Authorized official
• Waterfall Clinic, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Coos Bay, OR
  • NPI 1508133299
  NPD
• Waterfall Clinic, Incorporated

  dba Waterfall Behavorial Health Center

  • Psychiatric/Mental Health Nurse Practitioner
  • Coos Bay, OR
  • NPI 1619673704
  NPD

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1699276287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 E 5TH ST",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "974231699",
            "telephone_number": "541-396-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 E 5TH ST",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "974231755",
            "telephone_number": "541-396-3111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "66895 West St",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977039282",
            "country_code": "US",
            "telephone_number": "541-668-7683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ADAM",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-28",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09924908",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L8122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenda Gay Balneg, P.T.
• John William Brazer, MD
• Rebecca Elizabeth Brisco, PA-C
• Kevin Burch, DC
• City of Coquille
• Coastal Community Chiropractic LLC (Coquille Chiropractic)
• Coos Eye Centers, Inc. (Coquille Vision Center)
• Coquille Valley Health
• Coquille Valley Health
• Coquille Valley Health

• Clinical Social Worker in Coquille, OR
• Providers in Coquille, 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 Sep 3, 2020; 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.