NPIMap

Individual provider Active NPI

Michael H. Clark, M.D.

  • Family Medicine Physician
  • Newcastle, ME
National Provider Identifier
1982685459
Registry record updated Oct 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16528 Issued in ME
Practice address
80 River Road
New Castle, ME 04553-3838
Phone
(207) 563-3366
Fax
(207) 563-3393
NPI assigned
Nov 10, 2005
Last updated
Oct 22, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 16528 ME Primary

Addresses

Primary practice location

80 River Road
New Castle, ME 04553-3838

Mailing address

80 River Road
New Castle, ME 04553-3838
Phone (207) 563-3366

Other identifiers 1

IdentifierTypeStateIssuer
431565400MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20050112000835 ME Practitioner - Family Practice 5092764407 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Family Healthcare LLCGroup PAC ID 0547216459, 3 clinicians

Practice addresses (Care Compare)

80 River Rd
Newcastle, ME 04553-3838
Phone (207) 563-3366

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions66
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16528MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Family Healthcare LLC Family Medicine CurrentSince Jan 10, 2005 Accepting new patients
Mainehealth PastSince Oct 1, 2011 Accepting new patients

Locations

80 River Rd
Newcastle, ME 04553
Phone (207) 563-3206

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19131/brand/1/csg/1/fhir/r4
  • Direct secure messaging: michael.clark.1@19131.direct.athenahealth.com

Organizations & group practices 2

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 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256169600000",
    "number": "1982685459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 RIVER ROAD",
            "city": "NEW CASTLE",
            "state": "ME",
            "postal_code": "045533838",
            "telephone_number": "207-563-3366",
            "fax_number": "207-563-3393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 RIVER ROAD",
            "city": "NEW CASTLE",
            "state": "ME",
            "postal_code": "045533838",
            "telephone_number": "207-563-3366",
            "fax_number": "207-563-3393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAEL",
        "middle_name": "H.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2009-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "16528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "431565400",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newcastle, ME

Sources for this page

Verify at the official NPI Registry.