SUSAN B CLARK (MS, RD, LD, CDE) – Registered Dietitian, NPI 1124676663
Registered Dietitian
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
94 REGISTERED DIETITIAN OR NUTRITION PROFESSIONAL in ID
Provider Addresses for SUSAN B CLARK (MS, RD, LD, CDE)
450 E Main St
Rexburg, ID 834402048
Phone: (208) 359-6522
Type: Location
Madison Memorial Hospital, 450, East Main Street, Rexburg, Madison County, Idaho, 83440, United States
REXBURG, ID 834402048
Phone: (208) 359-6522
Type: Location
393 E 2ND N
REXBURG, ID 834401605
Phone: (208) 356-5401
Type: Location
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.
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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: 2020-03-18
PECOS data refreshed: 2026-05-27
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200318001657 | I | Registered Dietitian Or Nutrition Professional | ID | TBD |
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.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes | 75 | 19 | $0 |
Insurance plans in this area (ZIP 83440)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | ID | |
| Family Practice, Emergency Medicine | ID | |
| Physician Assistant | ID | |
| Internal Medicine | ID | |
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| P O D I A T R Y | ID | |
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| Orthopedic Surgery | ID | |
| Certified Nurse Midwife (Cnm) | ID | |
| P S Y C H I A T R Y | ID |
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