Tracy S Clark, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA06398 Issued in TX

Practice address

2115 Pleasanton Rd
San Antonio, TX 78221-1321

Phone

(210) 922-3627

Fax

(210) 977-9713

NPI assigned

Aug 12, 2009

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

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Wellmed Medical Group, PA

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1437156486
  Medicare reassignment NPD
• Fred E Griffiths

  • Geriatric Medicine (Family Medicine) Physician
  • Austin, TX
  • NPI 1609821719
  NPD (past)
• Hugo a. Rojas, M.D.,P.a.

  • Licensed Practical Nurse
  • San Antonio, TX
  • NPI 1518491240
  NPD (past)

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

{
    "created_epoch": "1250035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314057600000",
    "number": "1982836896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 PLEASANTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782211321",
            "telephone_number": "210-922-3627",
            "fax_number": "210-977-9713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 PLEASANTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782211321",
            "telephone_number": "210-922-3627",
            "fax_number": "210-977-9713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TRACY",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-12",
        "last_updated": "2011-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey S Clark, RN BSN
• Stephanie Clark
• Summer Michele Clark, ACNP
• Tammy Lynn Clark, M.A., LPC
• Taylor Clark, LPC
• William D Clark, MD
• Amber Lee Clarke, LPC-ASSOCIATE
• Angela Nicole Clarke
• Caroline Clarke
• Chantel R Clarke

• Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; 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.