Debra Clark, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1750471 Issued in NY

Practice address

1409 RT 9
Keeseville, NY 12944-2845

Phone

(518) 834-7271

Fax

(518) 834-7086

NPI assigned

Feb 1, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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.

Enrollment records 1

Specialty

Family Practice

Education

State University of Ny Upstate Medical University, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250
• Elizabethtown Community Hospital Hospital, Elizabethtown, NY, CCN 331302
• St Mary'S Medical Center Hospital, West Palm Beach, FL, CCN 100288
• Meadowbrook Healthcare Nursing home, Plattsburgh, NY, CCN 335438

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.

• CGSR, Inc

  • Skilled Nursing Facility
  • Plattsburgh, NY
  • NPI 1215930292
  Medicare reassignment NPD

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

• Champlain Valley Physicians Hospital Medical Center

  • General Acute Care Hospital
  • Plattsburgh, NY
  • NPI 1033270699
  Care Compare affiliation
• Elizabethtown Community Hospital

  • Ambulance
  • Elizabethtown, NY
  • NPI 1487923637

  Hospital

  Care Compare affiliation
• Elizabethtown Community Hospital

  • Critical Access Hospital
  • Elizabethtown, NY
  • NPI 1891785184
  Care Compare affiliation
• St. Mary'S Medical Center, Inc

  • General Acute Care Hospital
  • West Palm Beach, FL
  • NPI 1952333205
  Care Compare affiliation

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1962473397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 RT 9",
            "city": "KEESEVILLE",
            "state": "NY",
            "postal_code": "129442845",
            "telephone_number": "518-834-7271",
            "fax_number": "518-834-7086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 RT 9",
            "city": "KEESEVILLE",
            "state": "NY",
            "postal_code": "129442845",
            "telephone_number": "518-834-7271",
            "fax_number": "518-834-7086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DEBRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-01",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "1750471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01604324",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittney Marie Benway
• Teri Lynn Bourdeau, CASAC-ADVANCED
• John K Burgess
• Joseph Rene Charron, PT
• Children'S Development Group for Speech, Occupational, and Physical TH
• Marshia Ellen Desorcie, LCSW
• Jessica Drinkwine
• Cieara Elizabeth Duquette, LMSW
• Cassandra Lena Feazelle
• Judith Renee Feigenbaum, LMHC

• Family Medicine Physician in Keeseville, NY
• Providers in Keeseville, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.