Individual provider Active NPI

Emily Mossotti Clark, PA-C

  • Physician Assistant
  • Lexington, KY
National Provider Identifier
1821275520
Registry record updated Nov 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA991 Issued in KY
Practice address
1218 S Broadway
Suite 310
Lexington, KY 40504-2759
Phone
(859) 219-0542
Fax
(859) 219-9433
NPI assigned
Jan 24, 2008
Last updated
Nov 4, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA991 KY Primary

Addresses

Primary practice location

1218 S Broadway
Suite 310
Lexington, KY 40504-2759

Mailing address

1218 S Broadway
Suite 310
Lexington, KY 40504-2759
Phone (859) 219-0542

Other identifiers 1

IdentifierTypeStateIssuer
7100051790MedicaidKY

Other names 1

  • Miss Emily Anne Mossotti Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20160229000455 OH Practitioner - Physician Assistant 5991875023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Network Radiologists IncGroup PAC ID 7618960303, 74 clinicians

Practice addresses (Care Compare)

100 Medical Ctr Dr
Springfield, OH 45504-2687
Phone (937) 523-1000

1977 Miamisburg Centerville Rd
Dayton, OH 45459-3811
Phone (937) 439-6000

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8627

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342-7615
Phone (937) 296-7227

630 Eaton Ave
Hamilton, OH 45013-2767
Phone (513) 867-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.41 of 100Reported as group
Quality
73.46
Improvement activities
40
Cost
73.34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TC033KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc Current Accepting new patients
Kettering Medical Center Past Accepting new patients

Locations (25 of 40)

3535 Pentagon Blvd
Beavercreek, OH 45431
Phone (937) 702-4000

3371 Kemp Rd
Beavercreek, OH 45431
Phone (937) 320-3600

2510 Commons Blvd
Beavercreek, OH 45431
Phone (937) 223-2911

1023 S Main St
Centerville, OH 45458
Phone (937) 435-1982

101 E Alex Bell Rd
Ste 190
Dayton, OH 45459
Phone (937) 425-4020

6661 Clyo Rd
Dayton, OH 45459
Phone (937) 425-4000

3095 Dayton Xenia Rd
Ste 100
Dayton, OH 45434
Phone (937) 531-7902

6438 Wilmington Pike
Ste 120
Dayton, OH 45459
Phone (937) 558-3800

405 W Grand Ave
Dayton, OH 45405
Phone (937) 226-3200

7740 Washington Village Dr
Ste 140
Dayton, OH 45459
Phone (937) 439-7420

450 Washington Jackson Rd
#F
Eaton, OH 45320
Phone (937) 456-8376

1250 W National Rd
Englewood, OH 45315
Phone (937) 558-3062

1045 Channingway Dr
Fairborn, OH 45324
Phone (937) 878-8644

100 Kettering Way
Franklin, OH 45005
Phone (937) 458-4700

909 E 2nd St
Ste C
Franklin, OH 45005

630 Eaton Ave
Hamilton, OH 45013
Phone (513) 867-2000

2449 Ross Millville Rd
Hamilton, OH 45013
Phone (513) 422-6516

1391 Main St
Hamilton, OH 45013
Phone (513) 867-9000

8701 Troy Pike
Huber Heights, OH 45424
Phone (937) 558-3309

3535 Southern Blvd
Kettering, OH 45429
Phone (937) 298-1221

3700 Southern Blvd
Ste 106
Kettering, OH 45429
Phone (937) 281-3840

424 E Stroop Rd
#B
Kettering, OH 45429

1745 E Stroop Rd
Kettering, OH 45429
Phone (937) 281-6340

3700 Southern Blvd
Ste 201
Kettering, OH 45429
Phone (855) 500-2873

540 Lincoln Park Blvd
Ste 100
Kettering, OH 45429
Phone (937) 299-0900

Interoperability endpoints

  • Direct secure messaging: eclark570460@direct.ketteringhealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1201132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320364800000",
    "number": "1821275520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 S BROADWAY",
            "address_2": "SUITE 310",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042759",
            "telephone_number": "859-219-0542",
            "fax_number": "859-219-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 S BROADWAY",
            "address_2": "SUITE 310",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042759",
            "telephone_number": "859-219-0542",
            "fax_number": "859-219-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "EMILY",
        "middle_name": "MOSSOTTI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-24",
        "last_updated": "2011-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100051790",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "MOSSOTTI",
            "middle_name": "ANNE",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.