Kathy S Clark, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

01036050A Issued in IN

Practice address

5901 Technology Center Dr
Indianapolis, IN 46278-6013

Phone

(317) 328-5050

Fax

(317) 715-9965

NPI assigned

May 24, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Northwest Radiology Network P C

  • Diagnostic Radiology Physician
  • Indianapolis, IN
  • NPI 1447259338
  NPD
• Rush Memorial Hospital

  • Rural Health Clinic/Center
  • Rushville, IN
  • NPI 1659935781
  NPD (past)
• St Vincent Northwest Radiology LLC

  • Diagnostic Radiology Physician
  • Fishers, IN
  • NPI 1114978350
  NPD (past)
• St. Vincent Health Wellness and Preventive Care Institute, Inc.

  • Occupational Medicine Physician
  • Indianapolis, IN
  • NPI 1710300033
  NPD (past)

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475452800000",
    "number": "1952304701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 TECHNOLOGY CENTER DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462786013",
            "telephone_number": "317-328-5050",
            "fax_number": "317-328-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 TECHNOLOGY CENTER DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462786013",
            "telephone_number": "317-328-5050",
            "fax_number": "317-715-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATHY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-24",
        "last_updated": "2016-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01036050A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM-351158723",
            "identifier": "000000214716",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE-351158723",
            "identifier": "300128808",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM 203778927",
            "identifier": "000000492338",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100348870",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE-351158723",
            "identifier": "085331",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMOSHO351158723-352047427",
            "identifier": "Q0085630",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO-351158723",
            "identifier": "011838",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Clark, PTA
• Jesse N Clark, DO
• Jessica Ann Clark, M.A., CCC-SLP
• Karol Ann Clark, RN
• Katherine Clark, DDS
• Katie Clark, RBT
• Kelli Clark, DPT
• Kelly Marie Clark, NP
• Kimberly Clark
• Kristen Barbara Clark, MD

• Diagnostic Radiology Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Diagnostic Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; 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.