Active NPI
Marilyn K. Clark, M.D.
- Rheumatology Physician
- Temple, TX
National Provider Identifier
1851351845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- J1930
- Practice address
- 2401 S 31St St
Temple, TX 76508-0001 - Phone
- (254) 724-2111
- NPI assigned
- Mar 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | J1930 | TX | Primary |
Addresses
Primary practice location
2401 S 31St St
Temple, TX 76508-0001
Mailing address
PO Box 847408
Dallas, TX 75284-7408
Phone (254) 724-2111
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1056921-01 | Medicaid | TX | |
| 1056921-02 | Other | TX | CSHCN |
| 81756Y | Other | TX | BLUE SHIELD |
| 660003146 | Other | TX | RR/MEDICARE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mclark14064@direct.sw.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- mclark14064@direct.sw.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610496000000",
"number": "1851351845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 847408",
"city": "DALLAS",
"state": "TX",
"postal_code": "752847408",
"telephone_number": "254-724-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 S 31ST ST",
"city": "TEMPLE",
"state": "TX",
"postal_code": "765080001",
"telephone_number": "254-724-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MARILYN",
"middle_name": "K.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2021-01-13",
"certification_date": "2021-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "TX",
"license": "J1930",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1056921-01",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSHCN",
"identifier": "1056921-02",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "81756Y",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR/MEDICARE",
"identifier": "660003146",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mclark14064@direct.sw.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "2401 S 31st St",
"city": "Temple",
"state": "TX",
"country_code": "US",
"postal_code": "765080001",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Temple, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.