NPIMap

Individual provider Active NPI

Corina Scheel Clark, P.A.

  • Physician Assistant
  • Castro Valley, CA
National Provider Identifier
1720480049
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
59305 Issued in CA
Practice address
20642 John Dr
Castro Valley, CA 94546-5103
Phone
(510) 785-5000
NPI assigned
Sep 17, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA09166 TX
Physician Assistant 363A00000X 59305 CA Primary

Addresses

Primary practice location

20642 John Dr
Castro Valley, CA 94546-5103

Mailing address

20642 John Dr
Castro Valley, CA 94546-5103
Phone (510) 785-5000

Other practice location 1

1700 Keystone Pacific Pkwy
Patterson, CA 95363-8874
Phone (209) 892-9100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141124000606 TX Practitioner - Physician Assistant 2163744400 Reassigns benefits to 1 organization
I20221118002132 CA Practitioner - Physician Assistant 2163744400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Healthcare AllianceGroup PAC ID 6305748799, 334 clinicians

Practice addresses (Care Compare)

20642 John Dr
Castro Valley, CA 94546-5103
Phone (888) 924-1036

4725 1St St
Suite 100
Pleasanton, CA 94566-7366
Phone (925) 462-7060

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
59305CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Del Puerto Health Care District PastSince Dec 1, 2021 Accepting new patients
Texas Children'S Hospital Past Accepting new patients
Children'S Hospital Past Accepting new patients
Kids Way Clinic Past Accepting new patients
Affinity Medical Group Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: cclark396486@direct.stanfordhealthcare.org
  • FHIR API: https://api.platform.athenahealth.com/20554/brand/1/csg/1/fhir/r4

Organizations & group practices 7

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 9

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": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1720480049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20642 JOHN DR",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465103",
            "telephone_number": "510-785-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20642 JOHN DR",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465103",
            "telephone_number": "510-785-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 Keystone Pacific Pkwy",
            "address_purpose": "LOCATION",
            "city": "Patterson",
            "state": "CA",
            "postal_code": "953638874",
            "country_code": "US",
            "telephone_number": "209-892-9100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CORINA",
        "middle_name": "SCHEEL",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-17",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA09166",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "59305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Castro Valley, CA

Sources for this page

Verify at the official NPI Registry.