Michelle Ruth Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAN1716 Issued in ME

Practice address

144 State St
Portland, ME 04101-3776

Phone

(207) 899-5322

NPI assigned

Jul 30, 2017

Last updated

Jul 30, 2017By 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

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy HospitalGroup PAC ID 6103737812, 307 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northern Light Mercy Hospital Hospital, Portland, ME, CCN 200008

Merit-based Incentive Payment System (MIPS)

Final score

81.67 of 100Reported as group

Quality

60.7

Promoting interoperability

91

Improvement activities

40

Cost

73.8

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Mercy Hospital

  • General Acute Care Hospital
  • Portland, ME
  • NPI 1629078712
  Medicare reassignment Care Compare group NPD
• Mercy Hospital

  dba Northern Light Mercy Health Center

  • Rural Health Clinic/Center
  • Windham, ME
  • NPI 1396496378
  NPD

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

• Mercy Hospital

  dba Mercy Medical Associates

  • General Acute Care Hospital
  • Portland, ME
  • NPI 1427313048
  Care Compare affiliation
• Mercy Hospital

  • General Acute Care Hospital
  • Portland, ME
  • NPI 1629078712
  Care Compare affiliation

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

{
    "created_epoch": "1501372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501372800000",
    "number": "1750805982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 DANFORTH ST APT 2",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 STATE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013776",
            "telephone_number": "207-899-5322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHELLE",
        "middle_name": "RUTH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-30",
        "last_updated": "2017-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PAN1716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Wallace Clark, MSOTR/L
• Julie Ann Clark, LCSW
• Kathryn Alison Clark, LCSW
• Matthew Anthony Clark, DO
• Meagan Jenkins Clark, MD
• Nathaniel P Clark, LCPC-C
• Nicole TM Clark, ATC-L
• Troy William Clark, LCSW
• William P Clark
• Beth S Clarke, LCSW

• Physician Assistant in Portland, ME
• Providers in Portland, ME by specialty
• Physician Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2017; 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.