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KELLY JEANNE CLARK MD
NPI 1487806717
Family Medicine in Traverse City, MI

Active since October 17, 2008PECOS EnrolledAccepts Medicare Assignment
1400 MEDICAL CAMPUS DR, TRAVERSE CITY, MI 49684(231) 935-8031(231) 935-8099 Get Directions Write a Review

NPPES record last updated: February 10, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Kelly Jeanne Clark Md NPPES

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

KELLY JEANNE CLARK MD (NPI 1487806717) is an individual family medicine provider in Traverse City, Michigan, licensed in Michigan (4301090780) and active in the NPI registry since October 2008. She is enrolled in Medicare PECOS, is affiliated with Munson Medical Center, and maintains a secondary practice location in Traverse City.

NPPES Registry Identity

NPI1487806717
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameKELLY JEANNE CLARKCredential: MD
Location Address1400 MEDICAL CAMPUS DRTraverse City, MI 49684-7823
Mailing Address1400 Medical Campus DrTraverse City, MI 49684-7823 · (231) 935-8031 · Fax (231) 935-8099
Phone(231) 935-8031
Fax(231) 935-8099
Sole ProprietorYes
Medical School CMSOtherGraduated 2007
Enumeration DateOctober 17, 2008
Last NPPES UpdateFebruary 10, 2026
NPPES CertifiedFebruary 10, 2026
✔ NPI 1487806717 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MI · 4301090780
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1400 MEDICAL CAMPUS DR, Traverse City, MI 49684
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Secondary Practice Location 1

Location 11105 Sixth St Ste D6Traverse City, MI 49684-2345 · Phone (231) 935-6380 · Fax (231) 935-6920

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Jeanne Clark Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8921293531
PECOS Enrollment IDI20101110000163
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

3

Medicare enrollment records show Kelly Clark reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Munson Medical Center
Same address
Family Medicine
1400 MEDICAL CAMPUS DR
Traverse City, MI 49684
  • Reassigned Medicare billing, Michigan enrollment
  • 492 clinicians in this Medicare group
NPI 1922030162 (231) 935-8000
Munson Medical Group
Same address
Family Medicine
1400 MEDICAL CAMPUS DR
Traverse City, MI 49684
  • Reassigned Medicare billing, Michigan enrollment
  • 191 clinicians in this Medicare group
NPI 1861047060 (231) 935-8000
Munson Healthcare Cadillac
0.4 mi
Psychiatry
1105 SIXTH ST STE D6
Traverse City, MI 49684
  • Reassigned Medicare billing, Michigan enrollment
  • 156 clinicians in this Medicare group
NPI 1720955081 (231) 935-6380

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

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
105 services54 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
40 services33 patients
Annual depression screening, 5 to 15 minutes G0444
An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.
34 services34 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
33 services33 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
29 services14 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
14 services14 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Munson Medical Center

Acute Care Hospitals · Traverse City, MI
5/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number230097
Location1105 Sixth StreetTraverse City, MI 49684 · Grand Traverse County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49684 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
$84.74 typical visit price
range $54.34 – $166.68
Typical copayment $21.18 (range $13.58 – $41.67)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.09 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg J7613
DME-Drugs Administered Through DME · category DG006N
1 supplier12 claims1,788 services$0.03 avg. paid by Medicare
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg J7626
DME-Drugs Administered Through DME · category DG000N
1 supplier12 claims720 services$0.73 avg. paid by Medicare
Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram J7644
DME-Drugs Administered Through DME · category DG006N
1 supplier12 claims360 services$0.15 avg. paid by Medicare
Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513
DME-Other DME · category DE000N
1 supplier12 claims12 services$23.87 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

SATYA PILLAY DO
Family Medicine
1400 MEDICAL CAMPUS DR
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 935-8000
SAMANTHA K WINDLE D.O.
Family Medicine
1400 MEDICAL CAMPUS DR
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 935-8000
DR. ELENA NIKONOVA MD
Student in an Organized Health Care Education/Training Program
1400 MEDICAL CAMPUS DR
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 935-8000
KAITLYN LEE KILPATRICK DO
Family Medicine
1400 MEDICAL CAMPUS DR
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 935-8000
DR. GWENDOLYN M GRAVELIE MD
Family Medicine
1400 MEDICAL CAMPUS DR
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 935-8000
JACOB GEORGE FLYNN M.D.
Family Medicine
1400 MEDICAL CAMPUS DR
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 935-8000
BREANNA TRIBELHORN MD
Student in an Organized Health Care Education/Training Program
1400 MEDICAL CAMPUS DR
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 935-8000
NATALIE A GRAY MD
Family Medicine
1400 MEDICAL CAMPUS DR
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 935-8031

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 Kelly Clark's NPI number?

The NPI number for Kelly Clark is 1487806717. It was assigned to this individual provider in the NPPES registry on October 17, 2008.

Where is Kelly Clark located?

Kelly Clark practices at 1400 Medical Campus Dr, Traverse City, MI 49684. The listed phone number is (231) 935-8031.

What is Kelly Clark's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Kelly Clark enrolled in Medicare?

Yes. Kelly Clark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Kelly Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Clark reassigns Medicare benefits to 3 organizations: Munson Medical Center (Traverse City, MI), Munson Medical Group (Traverse City, MI) and Munson Healthcare Cadillac (Traverse City, MI). Each 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 Kelly Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Clark accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 2 other insurers list Kelly Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Kelly Clark affiliated with any hospitals?

According to CMS data, Kelly Clark is affiliated with Munson Medical Center.

When was this NPI record last updated?

The NPPES record for Kelly Clark was last updated on February 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.