CAMELLIA P CLARK MD INC
NPI 1689421471
Psychiatry & Neurology - Psychiatry in San Diego, CA
About Camellia P Clark Md Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CAMELLIA P CLARK MD INC (NPI 1689421471) is a healthcare organization registered as a psychiatry in San Diego, California and active in the NPI registry since May 2024. The organization lists Camellia Clark, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Camellia P Clark Md Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Camellia P Clark MD Inc, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Camellia P Clark MD Inc's NPI number?
The NPI number for Camellia P Clark MD Inc is 1689421471. It was assigned to this organization in the NPPES registry on May 1, 2024.
Where is Camellia P Clark MD Inc located?
Camellia P Clark MD Inc is located at 11515 El Camino Real Suite #100, San Diego, CA 92130. The listed phone number is (858) 263-5947.
What is Camellia P Clark MD Inc's specialty?
The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.
Is Camellia P Clark MD Inc enrolled in Medicare?
Yes. Camellia P Clark MD Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Camellia P Clark MD Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Psychiatry) reassigns their Medicare billing to Camellia P Clark MD Inc. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Camellia P Clark MD Inc was last updated on May 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Camellia P Clark Md Inc · NPI 1689421471
Psychiatry organization in San Diego, California. Organization record, active in the CMS NPPES registry since May 1, 2024.
## Identity
- **NPI:** 1689421471 (Entity type: Organization)
- **Enumerated:** May 1, 2024
- **Primary specialty:** Psychiatry & Neurology - Psychiatry · taxonomy 2084P0800X
- **Organization subpart:** No
- **Authorized official:** Camellia Clark, OWNER
## Practice location
- **Address:** 11515 EL CAMINO REAL, SUITE #100, San Diego, CA 92130
- **Phone:** (858) 263-5947
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Psychiatry) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 1, 2024
---
Source: [NPI Profile](https://npiprofile.com/npi/1689421471) · Data from the CMS NPPES public registry.