Carrie Jean Clark, D.O

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

4628 Issued in OK

Practice address

4401 S Wester
Oklahoma City, OK 73109

Phone

(405) 636-7500

NPI assigned

Dec 8, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

Locations

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.

• Emergency Services of Oklahoma PC

  • Emergency Medicine Physician
  • Norman, OK
  • NPI 1215249891
  Medicare reassignment NPD
• South Central Emergency Services PC

  • Emergency Medicine Physician
  • Stillwater, OK
  • NPI 1558663724
  Medicare reassignment NPD
• Integris Baptist Medical Center Inc

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1831103654
  NPD (past)
• Integris South Oklahoma City Hospital Corporation

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1457372625
  NPD (past)

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

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1942445804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 N INDEPENDENCE AVE STE 280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125555",
            "telephone_number": "405-951-2545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 S WESTER",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73109",
            "telephone_number": "405-636-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CARRIE",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-08",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "4628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Clark
• Amelia Jo Clark, PRSS
• Brandi Nicole Clark
• Brian E Clark
• Caitlyn Grace Clark, PHARMD
• Christina Jane Clark, PA
• Debra Bynum Clark, ARNP
• Dori Clark, M.S. CCC-SLP
• Elizabeth Lynne Clark
• Emilyanne Clark

• Emergency Medicine Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Emergency Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.