DR. KRISTIN L. CLARK M.D.
NPI 1710982756
Obstetrics & Gynecology in Green Bay, WI

Q: What is Kristin Clark's NPI number?

The NPI number for Kristin Clark is 1710982756. It was assigned to this individual provider in the NPPES registry on June 16, 2005.

Q: What is Kristin Clark's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Q: When was this NPI record last updated?

The NPPES record for Kristin Clark was last updated on November 26, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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 June 16, 2005PECOS EnrolledAccepts Medicare Assignment

1821 S WEBSTER AVE, GREEN BAY, WI 54301(920) 496-4700 Get Directions Write a Review

NPPES record last updated: November 26, 2019. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Nov 26, 2019, Sep 13, 2018, Aug 21, 2017 (3 updates tracked since 2017).

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About Dr. Kristin L. Clark M.d. NPPES

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

DR. KRISTIN L. CLARK M.D. (NPI 1710982756) is an individual obstetrics & gynecology provider in Green Bay, Wisconsin, licensed in Wisconsin (46761-020) and active in the NPI registry since June 2005. She is enrolled in Medicare PECOS, is affiliated with Thedacare Regional Med Ctr - Neenah, and maintains a secondary practice location in Neenah.

NPPES Registry Identity

NPI1710982756

Entity TypeIndividualFemale

Primary Taxonomy207V00000X

Provider Legal NameDR. KRISTIN L. CLARKCredential: M.D.

Location Address1821 S WEBSTER AVEGreen Bay, WI 54301-2253

Mailing Address5485 W Grande Market Dr Ste CAppleton, WI 54913-8430 · (920) 729-7105

Phone(920) 496-4700

Sole ProprietorNo

Medical School CMSUniversity Of Wisconsin School Of MedicineGraduated 2000

Enumeration DateJune 16, 2005

Last NPPES UpdateNovember 26, 20193 updates tracked since enumeration

✔ NPI 1710982756 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians

Taxonomy Code207V00000X

License✔ Licensed in WI · 46761-020

Definition

An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

1821 S WEBSTER AVE, Green Bay, WI 54301

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Secondary Practice Location 1

Location 1200 Theda Clark Medical Plz, Ste 130Neenah, WI 54956-2790 · Phone (920) 729-7105

Other Identifiers 1

Medicaid34577900WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare) and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Kristin L. Clark M.d. 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 ID7517933823

PECOS Enrollment IDI20040908000972

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.

Hospital Affiliations CMS Care Compare 2

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

Thedacare Regional Med Ctr - Neenah

Acute Care Hospitals · Neenah, WI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520045

Location130 2nd StNeenah, WI 54956 · Winnebago County

Emergency services Birthing friendly

Thedacare Regional Medical Center - Appleton Inc

Acute Care Hospitals · Appleton, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520160

Location1818 N Meade StAppleton, WI 54911 · Outagamie County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54301 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

$123.69 typical visit price

range $53.90 – $163.24

Typical copayment $30.92 (range $13.47 – $40.81)

Most-billed visit code 99204

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

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 20

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

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