Hana Clark, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A12456 Issued in CA

Practice address

1801 E Cotati Ave
Rohnert Park, CA 94928-3613

Phone

(707) 664-2921

NPI assigned

Apr 13, 2011

Last updated

Jan 4, 2022By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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 Osteopathy

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Family Medicine

  Medicare reassignment NPD
• Student Health Ctr Pharmacy

  • Student Health Clinic/Center
  • Rohnert Park, CA
  • NPI 1699838763
  NPD (past)

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

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1730479569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3569 ROUND BARN CIR STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954035784",
            "telephone_number": "707-303-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E COTATI AVE",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949283613",
            "telephone_number": "707-664-2921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "HANA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-13",
        "last_updated": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A12456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5900 State Farm Dr",
            "city": "Rohnert Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949282149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David R. Chipkin, MD
• Christine I Dimaio (Irenes Fitting Room)
• Christopher Murolo DDS a Professional Dental Corporation
• Victor Chu, DDS
• Christine Chuateco, RPH
• Katherine Sofia Cole, DO
• Dorothy Coleman-Riese, M.D.
• Shane Marley Collins
• Concentra Health Services, Inc.
• Conversa Speech & Language Therapy, PC

• Family Medicine Physician in Rohnert Park, CA
• Providers in Rohnert Park, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.