NPIMap

Individual provider Active NPI

Timothy Vaughan Clark, D.O.

  • Critical Care Medicine (Internal Medicine) Physician
  • Marysville, CA
National Provider Identifier
1932420320
Registry record updated Feb 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
20A13845 Issued in CA
Practice address
726 4TH St
Marysville, CA 95901-5656
Phone
(530) 743-4377
Fax
(530) 749-6616
NPI assigned
Jun 20, 2010
Last updated
Feb 24, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2016

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 OTO13674 PA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 20A13845 CA Primary

Addresses

Primary practice location

726 4TH St
Marysville, CA 95901-5656

Mailing address

PO Box 3067
Yuba City, CA 95992-3067
Phone (207) 939-4204

Other identifiers 1

IdentifierTypeStateIssuer
20A13845OtherCALICENSE

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
I20150901003345 CA Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 8921263757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America - Intensivists PCGroup PAC ID 9032423421, 112 clinicians

Practice addresses (Care Compare)

2825 Capitol Ave
Sacramento, CA 95816-6039
Phone (916) 887-1230

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13845CAMDMarriage & Family Therapist
OTO13674PAMDInternal Medicine Physician
20A13845CAMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Intensivists PC Critical Care Medicine CurrentSince Feb 1, 2020 Accepting new patients
Cep America - Intensivists PC Critical Care Medicine Current Accepting new patients
Cep America - Intensivists PC Critical Care Medicine CurrentSince Feb 1, 2020 Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1303 E Herndon Ave
Fresno, CA 93720
Phone (559) 449-3000

1050 Linden Ave
Long Beach, CA 90813
Phone (562) 491-9000

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

1150 N Indian Canyon Dr
Palm Springs, CA 92262
Phone (760) 323-6251

2825 Capitol Ave
Sacramento, CA 95816
Phone (916) 887-0000

Interoperability endpoints

  • Direct secure messaging: tclark338559@hisp.ehr.sutterhealth.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 4

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": "1276992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456272000000",
    "number": "1932420320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3067",
            "city": "YUBA CITY",
            "state": "CA",
            "postal_code": "959923067",
            "telephone_number": "207-939-4204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "726 4TH ST",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959015656",
            "telephone_number": "530-743-4377",
            "fax_number": "530-749-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TIMOTHY",
        "middle_name": "VAUGHAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-20",
        "last_updated": "2016-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OTO13674",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "20A13845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "20A13845",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marysville, CA

Sources for this page

Verify at the official NPI Registry.