NPIMap

Individual provider Active NPI

Mark Eliot Clyde, MD

  • Orthopaedic Surgery Physician
  • Palmer, AK
National Provider Identifier
1902840812
Registry record updated Dec 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
4734 Issued in AK
Practice address
2490 S. Woodworth Loop
Ste 350
Palmer, AK 99645-7411
Phone
(907) 745-2663
Fax
(907) 745-2600
NPI assigned
Jun 15, 2006
Last updated
Dec 12, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 4734 AK Primary

Addresses

Primary practice location

2490 S. Woodworth Loop
Ste 350
Palmer, AK 99645-7411

Mailing address

2490 S. Woodworth Loop
Ste 350
Palmer, AK 99645-7411
Phone (907) 745-2663

Other identifiers 2

IdentifierTypeStateIssuer
P00111691OtherMDCR RAILROAD
MD1984MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20190717000295 TX Practitioner - Orthopedic Surgery 7315942398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Uniformed Services Uhs Fe Hebert School of Med, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4734AKMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium CurrentSince Jun 19, 2019 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Jun 19, 2019 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients

Locations

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8519

Interoperability endpoints

  • Direct secure messaging: mclyde@direct-searhc.org

Organizations & group practices 4

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 35

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197417600000",
    "number": "1902840812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 S. WOODWORTH LOOP",
            "address_2": "STE 350",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996457411",
            "telephone_number": "907-745-2663",
            "fax_number": "907-745-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 S. WOODWORTH LOOP",
            "address_2": "STE 350",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996457411",
            "telephone_number": "907-745-2663",
            "fax_number": "907-745-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLYDE",
        "first_name": "MARK",
        "middle_name": "ELIOT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2007-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AK",
            "license": "4734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDCR RAILROAD",
            "identifier": "P00111691",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD1984",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmer, AK

Sources for this page

Verify at the official NPI Registry.