NPIMap

Individual provider Active NPI

Adam Bradley Clark, DO

  • Family Medicine Physician
  • Simi Valley, CA
National Provider Identifier
1861865610
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A16957 Issued in CA
Practice address
2876 Sycamore Dr Ste 101
Simi Valley, CA 93065-1550
Phone
(805) 527-0115
Fax
(805) 522-0115
NPI assigned
Nov 2, 2015
Last updated
Jun 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A16957 CA Primary
Hospitalist Physician 208M00000X A16957 CA
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

2876 Sycamore Dr Ste 101
Simi Valley, CA 93065-1550

Mailing address

2876 Sycamore Dr Ste 101
Simi Valley, CA 93065-1550
Phone (805) 527-0115

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200828001494 CA Practitioner - Emergency MedicinePractitioner - Family Practice 6406273986 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Western Un of HLTH Sciences, Col of Podiatric Med, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Galen Inpatient Physicians PCGroup PAC ID 3678464633, 1,045 clinicians

Practice addresses (Care Compare)

124 Macaw LN
Simi Valley, CA 93065-3152
Phone (805) 306-0304

1509 Wilson Ter
Glendale, CA 91206-4007
Phone (818) 409-8000

2950 Sycamore Dr
Simi Valley, CA 93065-1210

2975 Sycamore Dr
Simi Valley, CA 93065-1201
Phone (805) 955-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
82.4 of 100Reported as group
Quality
65.6
Improvement activities
40
Cost
71.06

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions13
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
A16957CAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Menalam Health Services PC CurrentSince Aug 1, 2021 Accepting new patients
Adventist Health Physicians Network Family Medicine Current Accepting new patients
Menalam Health Services PC Hospitalist CurrentSince Aug 1, 2021 Accepting new patients
Adventist Health Physicians Network CurrentSince Aug 16, 2020 Accepting new patients
Jonathan Nasseri MD Corp Family Medicine CurrentSince Sep 14, 2020 Accepting new patients
Galen Inpatient Physicians PC Hospitalist CurrentSince Jul 9, 2024 Accepting new patients
Galen Inpatient Physicians, PC Hospitalist Current Accepting new patients
Adventist Health Physicians Network CurrentSince Aug 16, 2020 Accepting new patients
Galen Inpatient Physicians PC. Hospitalist CurrentSince Jul 9, 2024 Accepting new patients
Stepanyan Past Accepting new patients
Adventist Health Heart Institute-Ukiah Past Accepting new patients
Family Practice of Glendale a Medical Corporation Family Medicine PastSince Jun 28, 2020 Accepting new patients

Locations

1509 Wilson Ter
Glendale, CA 91206
Phone (818) 409-8071

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

124 Macaw Ln
Simi Valley, CA 93065
Phone (805) 306-0304

2876 Sycamore Dr
Ste 101
Simi Valley, CA 93065
Phone (805) 527-6424

2950 Sycamore Dr
Ste 300
Simi Valley, CA 93065
Phone (805) 526-0226

2975 Sycamore Dr
Simi Valley, CA 93065
Phone (805) 522-2500

1534 N Moorpark Rd
Thousand Oaks, CA 91360
Phone (805) 497-1800

Organizations & group practices 12

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 7

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": "1446422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1861865610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2876 SYCAMORE DR STE 101",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651550",
            "telephone_number": "805-527-0115",
            "fax_number": "805-522-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2876 SYCAMORE DR STE 101",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651550",
            "telephone_number": "805-527-0115",
            "fax_number": "805-522-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ADAM",
        "middle_name": "BRADLEY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-02",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A16957",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A16957",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

Verify at the official NPI Registry.