Elizabeth Catherine Clark, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1346 Issued in WV

Practice address

200 W. Hospital Dr
Whiteriver, AZ 85941

Phone

(928) 338-4911

NPI assigned

Jul 31, 2006

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

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TX

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 Osteopathy

State licenses

Practice roles

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.

• DHHS IHS Phoenix Area

  • General Acute Care Hospital
  • Whiteriver, AZ
  • NPI 1427335140

  TX

  Medicare reassignment NPD
• DHHS IHS Phoenix Area

  • Clinic/Center
  • Cibecue, AZ
  • NPI 1427335181
  NPD

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229558400000",
    "number": "1922014182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "859410860",
            "telephone_number": "928-338-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W. HOSPITAL DR",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "85941",
            "telephone_number": "928-338-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELIZABETH",
        "middle_name": "CATHERINE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2008-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "WV",
            "license": "1346",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "1346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629236716",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780614008",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871523191",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295993376",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409757",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachael Caster, D.O.
• Casey L Cavanaugh, M.S., R.D.
• Kathleen Margaret Chamberlain, RN, BSN, CDE
• Kandy Leigh Chintis, RN
• Cynthia Chism
• Eben Clattenburg
• Cynda Jo Clift, RN
• Charles L Cole, PT
• John S Condojani, D.O.
• Patrick Eugene Conlisk, RN

• All providers in Whiteriver, AZ
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; 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.