DR. CAMELLIA P. CLARK M.D.
NPI 1174624399
Psychiatry & Neurology - Psychiatry in San Diego, CA

Q: What is Camellia Clark's NPI number?

The NPI number for Camellia Clark is 1174624399. It was assigned to this individual provider in the NPPES registry on September 26, 2006.

Q: What is Camellia Clark's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Q: When was this NPI record last updated?

The NPPES record for Camellia Clark was last updated on March 25, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.

Active since September 26, 2006PECOS Enrolled

4550 KEARNY VILLA RD STE 116, SAN DIEGO, CA 92123(858) 279-1223 Get Directions Write a Review

NPPES record last updated: March 25, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 25, 2021, Feb 13, 2020, Sep 30, 2019 and 2 more (5 updates tracked since 2018).

On this page

About Dr. Camellia P. Clark M.d. NPPES

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

DR. CAMELLIA P. CLARK M.D. (NPI 1174624399) is an individual psychiatry provider in San Diego, California, licensed in California (A052116) and active in the NPI registry since September 2006. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1174624399

Entity TypeIndividualFemale

Primary Taxonomy2084P0800X

Provider Legal NameDR. CAMELLIA P. CLARKCredential: M.D.

Location Address4550 KEARNY VILLA RD STE 116San Diego, CA 92123-1583

Mailing Address4550 Kearny Villa Rd Ste 116San Diego, CA 92123-1583 · (858) 279-1223

Phone(858) 279-1223

Sole ProprietorNo

Enumeration DateSeptember 26, 2006

Last NPPES UpdateMarch 25, 20215 updates tracked since enumeration

NPPES CertifiedMarch 25, 2021

✔ NPI 1174624399 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

License✔ Licensed in CA · A052116

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

4550 KEARNY VILLA RD STE 116, San Diego, CA 92123

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Secondary Practice Locations 2

Location 17850 Vista Hill AveSan Diego, CA 92123-2717 · Phone (619) 528-4600 · Fax (619) 528-4625

Location 29620 Chesapeake Dr Ste 206San Diego, CA 92123-1324 · Phone (619) 814-6590 · Fax (619) 814-6591

Other Identifiers 1

Medicaid004521160CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Camellia P. Clark M.d. 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.

Medicare Billing Reassignments

Medicare enrollment records show Camellia Clark reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Camellia P Clark MD Inc

9.0 mi

Psychiatry

11515 EL CAMINO REAL, SUITE #100
San Diego, CA 92130

Reassigned Medicare billing, California enrollment

NPI 1689421471 (858) 263-5947

Sondermind PC

402 mi

Clinical

6203 SAN IGNACIO AVE STE 110
San Jose, CA 95119

Reassigned Medicare billing, California enrollment
81 clinicians in this Medicare group

NPI 1003646977 (844) 843-7279

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92123 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

$184.71 typical visit price

range $62.10 – $184.71

Typical copayment $46.17 (range $15.52 – $46.17)

Most-billed visit code 99205

Established Patient

$76.87 typical visit price

range $20.62 – $151.42

Typical copayment $19.21 (range $5.15 – $37.85)

Most-billed visit code 99213

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 14

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

MS. CARA ANN MCDOWELL MFT

Marriage & Family Therapist