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DR. MICHALA EILEEN CLARK DO
NPI 1730973876
Student in an Organized Health Care Education/Training Program in Peoria, IL

Active since April 05, 2025PECOS Enrolled
815 MAIN ST STE C, PEORIA, IL 61602(309) 672-4977 Get Directions Write a Review

NPPES record last updated: April 5, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Michala Eileen Clark Do NPPES

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

DR. MICHALA EILEEN CLARK DO (NPI 1730973876) is an individual student in an organized health care education/training program in Peoria, Illinois, licensed in Illinois (00000000000000000000) and active in the NPI registry since April 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1730973876
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameDR. MICHALA EILEEN CLARKCredential: DO
Location Address815 MAIN ST STE CPeoria, IL 61602-1080
Mailing Address815 Main St Ste CPeoria, IL 61602-1080
Phone(309) 672-4977
Sole ProprietorNo
Enumeration DateApril 5, 2025
NPPES CertifiedApril 4, 2025
✔ NPI 1730973876 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in IL · 00000000000000000000
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
815 MAIN ST STE C, Peoria, IL 61602
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Michala Eileen Clark Do 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.

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.

DR. THOMAS TSZ HIM CHOW DO
Student in an Organized Health Care Education/Training Program
815 MAIN ST STE C
PEORIA, IL 61602
Peoria County (309) 672-4977
KYLE COTNER MD
Student in an Organized Health Care Education/Training Program
815 MAIN ST STE C
PEORIA, IL 61602
Peoria County (309) 672-4977
DEMI CASTELLANOS
Student in an Organized Health Care Education/Training Program
815 MAIN ST STE C
PEORIA, IL 61602
Peoria County (309) 672-4977
PATRECE ANTOINETTE BARKER D.O., M.S.
Family Medicine
815 MAIN ST STE C
PEORIA, IL 61602
Peoria County (309) 672-4986
PAIGE ELIZABETH BONNER DO
Student in an Organized Health Care Education/Training Program
815 MAIN ST STE C
PEORIA, IL 61602
Peoria County (309) 672-4977
JEFFREY S. LEMAN MD
Family Medicine
815 MAIN ST STE C
PEORIA, IL 61602
Peoria County (309) 672-4977
DR. KRISHNA SASANKA BATHINA MD
Family Medicine
815 MAIN ST STE C
PEORIA, IL 61602
Peoria County (309) 672-4977
RIDA MOHAMMAD GAREEB MD
Family Medicine
815 MAIN ST STE C
PEORIA, IL 61602
Peoria County (309) 672-4986

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 Michala Clark's NPI number?

The NPI number for Michala Clark is 1730973876. It was assigned to this individual provider in the NPPES registry on April 5, 2025.

Where is Michala Clark located?

Michala Clark practices at 815 Main St Ste C, Peoria, IL 61602. The listed phone number is (309) 672-4977.

What is Michala Clark's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Michala Clark enrolled in Medicare?

Yes. Michala Clark is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Michala Clark was last updated on April 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.