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MR. JACK MALCOLM CLARK III LCSW
NPI 1841311487
Social Worker - Clinical in San Antonio, TX

Active since April 02, 2007PECOS Enrolled
7711 MADONNA, SAN ANTONIO, TX 78216(210) 377-1133(210) 377-1230 Get Directions Write a Review

NPPES record last updated: May 24, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mr. Jack Malcolm Clark Iii Lcsw NPPES

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

MR. JACK MALCOLM CLARK III LCSW (NPI 1841311487) is an individual clinical provider in San Antonio, Texas, licensed in Texas (36151) and active in the NPI registry since April 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1841311487
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameMR. JACK MALCOLM CLARK IIICredential: LCSW
Location Address7711 MADONNASan Antonio, TX 78216-6620
Mailing AddressBrooke Army Medical CenterFt. Sam Houston, TX 78234-4504 · (210) 916-3704 · Fax (210) 916-8410
Phone(210) 377-1133
Fax(210) 377-1230
Sole ProprietorNo
Enumeration DateApril 2, 2007
Last NPPES UpdateMay 24, 2021
NPPES CertifiedMay 12, 2021
✔ NPI 1841311487 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in TX · 36151
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
7711 MADONNA, San Antonio, TX 78216
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Other Identifiers 2

Medicaid175693402TX
Other87614QTX · Clark Bcbs

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Jack Malcolm Clark Iii Lcsw 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 Reassignment

Medicare enrollment records show Jack Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Catholic Charities Archdiocese Of San Antonio Inc
8.4 mi
Clinical
2911 S NEW BRAUNFELS AVE
San Antonio, TX 78210
  • Reassigned Medicare billing, Texas enrollment
  • 8 clinicians in this Medicare group
NPI 1669506192 (210) 377-1133

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 78216 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
$0.00 typical visit price
range $54.84 – $166.88
Typical copayment $0.00 (range $13.71 – $41.72)
Most-billed visit code NA
Established Patient
$68.55 typical visit price
range $17.52 – $136.11
Typical copayment $17.13 (range $4.38 – $34.02)
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 2

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

MISS GERALDINE MARIE KLINE LPC
Counselor (Mental Health)
7711 MADONNA
SAN ANTONIO, TX 78216
Bexar County (210) 377-1133
MR. NICHOLAS JAMES RUTKOWSKI LCSW
Social Worker (Clinical)
7711 MADONNA
SAN ANTONIO, TX 78216
Bexar County (210) 377-1133

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 Jack Clark's NPI number?

The NPI number for Jack Clark is 1841311487. It was assigned to this individual provider in the NPPES registry on April 2, 2007.

Where is Jack Clark located?

Jack Clark practices at 7711 Madonna, San Antonio, TX 78216. The listed phone number is (210) 377-1133.

What is Jack Clark's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Jack Clark enrolled in Medicare?

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

Which organization bills Medicare for Jack Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Clark reassigns Medicare benefits to Catholic Charities Archdiocese Of San Antonio Inc (San Antonio, TX). The 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 Jack Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jack Clark was last updated on May 24, 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.