Teresa Clark, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

E-1370 Issued in AR

Practice address

1200 W Walnut St
Rogers, AR 72756-3546

Phone

(479) 636-0200

NPI assigned

Jun 5, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Sgoh Acquisition Inc

  • Critical Access Hospital
  • Gravette, AR
  • NPI 1568643005
  Medicare reassignment NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  AR

  Medicare reassignment NPD
• Sgoh Acquisition Inc

  • Rural Health Clinic/Center
  • Decatur, AR
  • NPI 1699513507
  NPD

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1699714857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 634706",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452630001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W WALNUT ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727563546",
            "telephone_number": "479-636-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Jackson St SW",
            "address_purpose": "LOCATION",
            "city": "Gravette",
            "state": "AR",
            "postal_code": "727369121",
            "country_code": "US",
            "telephone_number": "479-787-5291",
            "fax_number": "479-344-6404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TERESA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E-1370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133747001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5K667",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205182900",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Christine Clark
• Nicole Clark, SLP
• Roberta Anne Clark, APN
• Ryan Clark, PT, DPT
• Stephanie M Clark
• Joyce Clarkson, MA CCC-SLP
• Deborah Jane Clay, LPC
• Rhonda Cleavenger
• Christy Clement, LMSW
• Doris Clement, PT

• Emergency Medicine Physician in Rogers, AR
• Providers in Rogers, AR by specialty
• Emergency Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.