NPIMap

Individual provider Active NPI

Mary Johanna Clark, DO

  • Internal Medicine Physician
  • La Crosse, WI
National Provider Identifier
1912917949
Registry record updated Oct 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
81803 Issued in WI
Practice address
700 West Ave S
La Crosse, WI 54601-8806
Phone
(608) 785-0940
NPI assigned
Aug 9, 2006
Last updated
Oct 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 81803 WI Primary
Internal Medicine Physician 207R00000X 29800 CO

Addresses

Primary practice location

700 West Ave S
La Crosse, WI 54601-8806

Mailing address

PO Box 860912
Minneapolis, MN 55486-0912
Phone (608) 785-0940

Other practice location 1

2121 North Ave
Grand Junction, CO 81501-6428
Phone (970) 242-0731

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mclark2569324@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20251014001484 WI Practitioner - Internal Medicine 5597654186 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

700 W Ave S
La Crosse, WI 54601-4783
Phone (608) 785-0940

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29800COMDInternal Medicine Physician
81803WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Oct 2, 2025 Accepting new patients
Steven L Peterson Professional LLC Past Accepting new patients
Eldercare , LLC Past Accepting new patients
Rdhealthcare LLC PastSince Dec 3, 2013 Accepting new patients
Inpatient Consultants of Colorado, PC Internal Medicine Past Accepting new patients
Community Medical Group, LLC Past Accepting new patients
Med-X., P.C. Past Accepting new patients

Locations

700 West Ave S
La Crosse, WI 54601
Phone (608) 791-4156

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

Interoperability endpoints

  • Direct secure messaging: mclark2569324@ehrdirect.mayoclinicmsg.org

Organizations & group practices 8

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1912917949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860912",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860912",
            "telephone_number": "608-785-0940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WEST AVE S",
            "city": "LA  CROSSE",
            "state": "WI",
            "postal_code": "546018806",
            "telephone_number": "608-785-0940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2121 North Ave",
            "address_purpose": "LOCATION",
            "city": "Grand Junction",
            "state": "CO",
            "postal_code": "815016428",
            "country_code": "US",
            "telephone_number": "970-242-0731",
            "fax_number": "970-248-5595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARY",
        "middle_name": "JOHANNA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "81803",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "29800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mclark2569324@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "700 West Ave S",
            "city": "La  Crosse",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546018806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.