NPIMap

Individual provider Active NPI

Susannah Taylor Clark, M.D.

  • Internal Medicine Physician
  • Lebanon, NH
National Provider Identifier
1780697334
Registry record updated Nov 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
12781 Issued in NH
Practice address
1 Medical Center Dr
DHMC Department of General Internal Medicine
Lebanon, NH 03756-1000
Phone
(603) 650-5000
NPI assigned
Aug 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 12781 NH Primary

Addresses

Primary practice location

1 Medical Center Dr
DHMC Department of General Internal Medicine
Lebanon, NH 03756-1000

Mailing address

1 Medical Center Dr
DHMC - Department of General Internal Medicine
Lebanon, NH 03756-1000
Phone (603) 650-5000

Other identifiers 2

IdentifierTypeStateIssuer
30205694MedicaidNH
1011886MedicaidVT

Other names 1

  • Susannah Cord Taylor Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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
I20051006000242 NH Practitioner - Internal Medicine 6002884319 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Geisel School of Medicine at Dartmouth, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alice Peck Day Memorial HospitalGroup PAC ID 6103737531, 132 clinicians

Practice addresses (Care Compare)

5 Alice Peck Day Dr
Lebanon, NH 03766-2901
Phone (603) 448-3122

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.66 of 100Reported as apm
Quality
53.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Dartmouth-Hitchcock Clinic Internal Medicine CurrentSince Sep 26, 2005 Accepting new patients
Alice Peck Day Memorial Hospital Internal Medicine CurrentSince Sep 1, 2015 Accepting new patients
Alice Peck Day Memorial Hospital Internal Medicine Current Accepting new patients

Locations

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

10 Alice Peck Day Dr
Lebanon, NH 03766
Phone (603) 448-7440

5 Alice Peck Day Dr
Lebanon, NH 03766
Phone (603) 448-3996

Interoperability endpoints

  • Direct secure messaging: clarks@apdmh.gwaydirect.com
  • Direct secure messaging: sclark11776@direct.dartmouth-hitchcock.org
  • FHIR API: https://edhwebportal.hitchcock.org/FHIRProxy/api/FHIR/R4/

Organizations & group practices 3

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 8

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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415059200000",
    "number": "1780697334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "address_2": "DHMC - DEPARTMENT OF GENERAL INTERNAL MEDICINE",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "address_2": "DHMC DEPARTMENT OF GENERAL INTERNAL MEDICINE",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SUSANNAH",
        "middle_name": "TAYLOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2014-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "12781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30205694",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011886",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSANNAH",
            "last_name": "TAYLOR",
            "middle_name": "CORD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.