SUE CLARK MD
NPI 1174597371
Pediatrics - Developmental - Behavioral Pediatrics in Peoria, IL
About Sue Clark Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SUE CLARK MD (NPI 1174597371) is an individual developmental - behavioral pediatrics provider in Peoria, Illinois and active in the NPI registry since February 2006.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Sue Clark Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Sue Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Peoria, IL 61605
- Reassigned Medicare billing, Illinois enrollment
- 2,127 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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 Sue Clark's NPI number?
The NPI number for Sue Clark is 1174597371. It was assigned to this individual provider in the NPPES registry on February 14, 2006.
Where is Sue Clark located?
Sue Clark practices at 507 E Armstrong Ave Regional Development Center, Peoria, IL 61603. The listed phone number is (309) 681-6960.
What is Sue Clark's specialty?
The primary specialty registered for this NPI is Pediatrics, specializing in Developmental - Behavioral Pediatrics, with taxonomy code 2080P0006X.
Is Sue Clark enrolled in Medicare?
Yes. Sue Clark is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Sue Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Sue Clark reassigns Medicare benefits to Board Of Trustees Of The University Of Illinois (Peoria, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Sue Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Sue Clark was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Sue Clark, MD · NPI 1174597371
Developmental - Behavioral Pediatrics physician in Peoria, Illinois. Individual provider, active in the CMS NPPES registry since February 14, 2006.
## Identity
- **NPI:** 1174597371 (Entity type: Individual)
- **Enumerated:** February 14, 2006
- **Primary specialty:** Pediatrics - Developmental - Behavioral Pediatrics · taxonomy 2080P0006X
- **Sole proprietor:** No
## Practice location
- **Address:** 507 E ARMSTRONG AVE, REGIONAL DEVELOPMENT CENTER, Peoria, IL 61603-3201
- **Phone:** (309) 681-6960
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Board Of Trustees Of The University Of Illinois (NPI 1467425322, Peoria, IL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 13, 2026
- **Other identifiers:** Other 07215036 (IL); Other IL01Z4 (IL)
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Source: [NPI Profile](https://npiprofile.com/npi/1174597371) · Data from the CMS NPPES public registry.