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ELLEN P. CLARK MD
NPI 1154061711
Internal Medicine - Gastroenterology in Salt Lake City, UT

Active since March 31, 2022PECOS Enrolled
30 N MARIO CAPECCHI DR RM 3N100, SALT LAKE CITY, UT 84112(801) 581-2121 Get Directions Write a Review

NPPES record last updated: April 14, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ellen P. Clark Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELLEN P. CLARK MD (NPI 1154061711) is an individual gastroenterology provider in Salt Lake City, Utah, licensed in Utah (14211395-1205) and active in the NPI registry since March 2022. She is enrolled in Medicare PECOS and maintains a secondary practice location in Portland.

NPPES Registry Identity

NPI1154061711
Entity TypeIndividualFemale
Primary Taxonomy207RG0100X
Provider Legal NameELLEN P. CLARKCredential: MD
Location Address30 N MARIO CAPECCHI DR RM 3N100Salt Lake City, UT 84112
Mailing Address30 N Mario Capecchi Dr Rm 3n100Salt Lake City, UT 84112 · (801) 581-2121
Phone(801) 581-2121
Sole ProprietorNo
Enumeration DateMarch 31, 2022
Last NPPES UpdateApril 14, 2025
NPPES CertifiedApril 8, 2025
✔ NPI 1154061711 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code207RG0100X
License✔ Licensed in UT · 14211395-1205
Definition
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
30 N MARIO CAPECCHI DR RM 3N100, Salt Lake City, UT 84112
Open in Google Maps ↗

Secondary Practice Location 1

Location 13181 SW Sam Jackson Park RdPortland, OR 97239-3011 · Phone (503) 494-8607

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ellen P. Clark Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84112 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$125.70 typical visit price
range $54.34 – $166.03
Typical copayment $31.42 (range $13.58 – $41.50)
Most-billed visit code 99204
Established Patient
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MERIDETH BROOKE CHILTON MD
Internal Medicine (Nephrology)
30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE CITY, UT 84112
Salt Lake County (801) 581-2121
DANIEL P. VANDERHOEF MD
Internal Medicine (Pulmonary Disease)
30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE CITY, UT 84112
Salt Lake County (801) 581-2121
BHAVREET SINGH MBBS
Internal Medicine (Infectious Disease)
30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE CITY, UT 84112
Salt Lake County (801) 581-2121
JOHN PITTMAN MD
Internal Medicine
30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE CITY, UT 84112
Salt Lake County (801) 581-2121
REZA NASROLLAHZADEH DO
Internal Medicine (Sleep Medicine)
30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE CITY, UT 84112
Salt Lake County (801) 408-3617
DR. KELSEY J KLINGEL DO
Internal Medicine (Pulmonary Disease)
30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE CITY, UT 84112
Salt Lake County (801) 581-7693
SRIKAR SAMA M.D.
Internal Medicine (Rheumatology)
30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE CITY, UT 84112
Salt Lake County (801) 581-2121
MATTHEW BRUNER MD
Internal Medicine (Interventional Cardiology)
30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE CITY, UT 84112
Salt Lake County (801) 585-7676

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ellen Clark's NPI number?

The NPI number for Ellen Clark is 1154061711. It was assigned to this individual provider in the NPPES registry on March 31, 2022.

Where is Ellen Clark located?

Ellen Clark practices at 30 N Mario Capecchi Dr Rm 3n100, Salt Lake City, UT 84112. The listed phone number is (801) 581-2121.

What is Ellen Clark's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Is Ellen Clark enrolled in Medicare?

Yes. Ellen Clark is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ellen Clark was last updated on April 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.