Clark Family Medicine, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CLARK FAMILY MEDICINE, LLC

Practice address

1200 E Woodhurst Dr
Suite Q-200
Springfield, MO 65804-4261

Phone

(417) 881-5639

Fax

(417) 881-5664

NPI assigned

Dec 16, 2008

Last updated

Dec 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan Lee Clark, MDNPI 1164415204

Title

Physician

Phone

(417) 881-5639

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jonathan Clark

  • Family Medicine Physician
  • Springfield, MO
  • NPI 1164415204
  Medicare reassignment NPD Authorized official
• Patricia Wagner, DNP, NP-BC

  • Gerontology Nurse Practitioner
  • Springfield, MO
  • NPI 1770031759
  NPD (past)

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

{
    "created_epoch": "1229385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229385600000",
    "number": "1841435138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E WOODHURST DR",
            "address_2": "SUITE Q-200",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044261",
            "telephone_number": "417-881-5639",
            "fax_number": "417-881-5664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E WOODHURST DR",
            "address_2": "SUITE Q-200",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044261",
            "telephone_number": "417-881-5639",
            "fax_number": "417-881-5664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-16",
        "last_updated": "2008-12-16",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "417-881-5639",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Cillessen, PHARMD, RPH
• Sarah A Cimino, D.D.S
• City of Springfield (Springfield-Greene County Health Department)
• City Utilities of Springfield, Missouri
• Clarest Health 7931, LLC
• Autumn Clark, DO
• Brittney Nichole Clark, LMT
• Elizabeth Lee Clark, OTR/L
• Jonathan Clark
• Kathryn S Clark, FNP

• Primary Care Clinic/Center in Springfield, MO
• Providers in Springfield, MO by specialty
• Primary Care Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.