DR. SCOTT CLARK (MD) – Dermatology Physician, NPI 1366447740

DR. SCOTT CLARK (MD) is a healthcare provider. based in Longmont, Colorado. specializing in DERMATOLOGY. They hold the professional credentials MD. They hold a License No. 25764 (CO). The NPI Number for DR. SCOTT CLARK (MD) is 1366447740

Main info

Male
46 Years Of Experience
Accepts Medicare Assignment
Name
DR. SCOTT CLARK (MD)
NPI
1366447740
Phone
(303) 776-1234
Address
1925 W MOUNTAIN VIEW AVE
Enumeration Date
14 June 2005
Last Update Date
10 March 2015

Doctor Profile

Medical School Name
BAYLOR COLLEGE OF MEDICINE
Secondary Phone
3038338880
Graduation Year
1980 (46 years ago)
PAC ID
8628962933
Group Practice PAC ID
9638208549
Professional Enrollment ID
I20100826001220
Address ID
CO805045873FI11083BLVD300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:21State licenses:1Digital endpointsOther names

364 DERMATOLOGY in CO

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Provider Addresses for DR. SCOTT CLARK (MD)

  • Mountain View Avenue, Longmont, Boulder County, Colorado, 80501-2038, United States

    LONGMONT, CO 805013128

    Phone: (303) 776-1234

    Fax: (720) 494-3107

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-08-26

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20100826001220IDermatologyCOTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths657139$0
99213Established patient office or other outpatient visit, 20-29 minutes407310$0
17000Destruction of precancer skin growth, 1 growth216192$0
17110Destruction of skin growth, 1-14 growths128113$0
99212Established patient office or other outpatient visit, 10-19 minutes6562$0
View full utilization report →

Insurance plans in this area (ZIP 80501)

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Provider's Procedures

DR. SCOTT CLARK (MD) performs procedures in DERMATOLOGY. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYCO17003Destruction of 2-14 skin growths2015353

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9638208549View full group profile
NameSpecialtyState
Pulmonary DiseaseCO
-CO
-CO
-MO
Physician AssistantCO
-CO
Hospitalist, Internal MedicineNY
Physician AssistantCO
Physician AssistantCO
Nurse PractitionerCO

Reviews

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Frequently asked questions

Is DR. SCOTT CLARK (MD) listed with a National Provider Identifier?
Yes — DR. SCOTT CLARK (MD) has NPI 1366447740 on file in the registry.
Would DR. SCOTT CLARK (MD) appear as active to a payer?
You can treat DR. SCOTT CLARK (MD) as active for directory purposes; confirm clinical privileges separately.
What area of care is associated with DR. SCOTT CLARK (MD)?
DR. SCOTT CLARK (MD)'s record emphasizes Dermatology Physician. Clinical services aligned with this taxonomy classification.
Where in Colorado is DR. SCOTT CLARK (MD) registered?
Use Longmont, Colorado as the headline location for DR. SCOTT CLARK (MD) here.
When was this NPI issued?
Enumeration for DR. SCOTT CLARK (MD) is noted as June 14, 2005 where the registry provides it.

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