Amy Clark, LCSW, SAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8789-123 Issued in WI

Practice address

9200 W Loomis Rd Ste 217
Franklin, WI 53132

Phone

(414) 773-4312

NPI assigned

Apr 11, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Prohealth Medical Group Inc.

  • Pediatrics Physician
  • Waukesha, WI
  • NPI 1356322440
  Medicare reassignment Care Compare group NPD
• Prohealth Medical Group Inc

  • Family Medicine Physician
  • Waukesha, WI
  • NPI 1720371719
  NPD

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1851898233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W LOOMIS RD STE 217",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "531328887",
            "telephone_number": "414-773-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W LOOMIS RD STE 217",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "53132",
            "telephone_number": "414-773-4312"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 30th Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531441642",
            "country_code": "US",
            "telephone_number": "262-654-0487",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "AMY",
        "credential": "LCSW, SAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "16182-132",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "8789-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100077875",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aclark226142@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9200 W Loomis Rd Ste 217",
            "city": "Franklin",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53132",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "9200 W Loomis Rd Ste 217",
            "city": "Franklin",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Scott Christofferson
• Michael S Cianciolo, MD
• Mary Ellen Cieslak, RN
• City of Franklin
• City of Franklin
• Brian K Clark, LCSW
• David J Clark, MD
• Julie Ann Cleary, RN
• Heidi Clement, LCSW, SAC-IT
• Clifden Court Operations LLC

• Clinical Social Worker in Franklin, WI
• Providers in Franklin, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.