NPIMap

Individual provider Active NPI

Troy William Clark, LCSW

  • Clinical Social Worker
  • Portland, ME
National Provider Identifier
1699884619
Registry record updated Jan 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC1376 Issued in ME
Practice address
216 Vaughan St
Portland, ME 04102-3204
Phone
(207) 662-2221
Fax
(207) 662-7081
NPI assigned
Aug 30, 2006
Last updated
Jan 7, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC1376 ME Primary

Addresses

Primary practice location

216 Vaughan St
Portland, ME 04102-3204

Mailing address

216 Vaughan St
Portland, ME 04102-3204
Phone (207) 662-2221

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050725000952 ME Practitioner - Clinical Social Worker 3476580184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

216 Vaughan St
Portland, ME 04102-3204
Phone (207) 662-2221

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Sep 29, 2002 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Sep 29, 2002 Accepting new patients
Curtis Winchenbach PA Past Accepting new patients

Locations

216 Vaughan St
Portland, ME 04102
Phone (207) 662-2221

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

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

Hospital & facility affiliations 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231286400000",
    "number": "1699884619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 VAUGHAN ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023204",
            "telephone_number": "207-662-2221",
            "fax_number": "207-662-7081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 VAUGHAN ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023204",
            "telephone_number": "207-662-2221",
            "fax_number": "207-662-7081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TROY",
        "middle_name": "WILLIAM",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC1376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.