Marcella Ruth Clark, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301054607 Issued in MI

Practice address

7700 2ND Ave
Detroit, MI 48202-2411

Phone

(313) 202-8785

Fax

(313) 202-6870

NPI assigned

May 2, 2007

Last updated

Oct 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• Institute of Supportive Services, Inc.

  • Methadone Clinic
  • Detroit, MI
  • NPI 1346613403
  Medicare reassignment NPD
• Metropolitan Rehabilitation Clinics, Inc.

  dba Metro Recovery Center

  • Methadone Clinic
  • Oak Park, MI
  • NPI 1811020035
  Medicare reassignment NPD
• Western Wayne Family Health Centers

  • Federally Qualified Health Center (FQHC)
  • Inkster, MI
  • NPI 1972530277
  Medicare reassignment
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MI

  Medicare reassignment
• Western Wayne Family Health Centers

  • Federally Qualified Health Center (FQHC)
  • Dearborn, MI
  • NPI 1649820986
  NPD
• House Calls Physicians PLLC

  • Home Health Agency
  • Allen Park, MI
  • NPI 1033273008
  NPD (past)

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633132800000",
    "number": "1902028913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21040 GREENFIELD RD",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482373025",
            "telephone_number": "248-967-6130",
            "fax_number": "248-967-6552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022411",
            "telephone_number": "313-202-8785",
            "fax_number": "313-202-6870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARCELLA",
        "middle_name": "RUTH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2021-10-02",
        "certification_date": "2021-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301054607",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301054607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelli Eileen Clark
• Kristen Marie Clark, CRNA
• Latasha Clark
• Latoya Clark
• Lincolin Henry Clark, FAODP
• Marvin Clark, CCHW
• Mary L Clark
• Maya Clark, NP
• Melba Lynette Clark
• Melissa Clark

• Internal Medicine Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.