NPIMap

Organization Active NPI

Clarke Podiatry, LLC

  • Foot & Ankle Surgery Podiatrist
  • Milton Freewater, OR
National Provider Identifier
1790295228
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
DP00283 Issued in OR
Legal business name
CLARKE PODIATRY, LLC
Practice address
113 S Main St
Milton Freewater, OR 97862-1342
Phone
(541) 786-2321
Fax
(541) 854-4020
NPI assigned
Oct 11, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Dr. Stacey J. Clarke, DPMNPI 1437157260
Title
Owner
Phone
(541) 786-2321

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X DP00283 OR Primary
Foot Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0131X DP00283 OR

Addresses

Primary practice location

113 S Main St
Milton Freewater, OR 97862-1342

Mailing address

PO Box 687
Milton Freewater, OR 97862-0687
Phone (541) 786-2321

Other identifiers 2

IdentifierTypeStateIssuer
6805300OtherORBLUE CROSS BLUE SHIELD
150541MedicaidOR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1790295228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 687",
            "city": "MILTON FREEWATER",
            "state": "OR",
            "postal_code": "978620687",
            "telephone_number": "541-786-2321",
            "fax_number": "541-854-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 S MAIN ST",
            "city": "MILTON FREEWATER",
            "state": "OR",
            "postal_code": "978621342",
            "telephone_number": "541-786-2321",
            "fax_number": "541-854-4020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKE PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-11",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-786-2321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "DP00283",
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "OR",
            "license": "DP00283",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "6805300",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150541",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milton Freewater, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.