JACK O. CLARK (M.D.) – Internal Medicine Physician, NPI 1902992837
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
559 INTERNAL MEDICINE in ID
Provider Addresses for JACK O. CLARK (M.D.)
166 S 5th St
SUITE B
Montpelier, ID 832541557
Phone: (208) 847-1110
Fax: (208) 847-0228
Type: Location
Madison Memorial Hospital, 450, East Main Street, Rexburg, Madison County, Idaho, 83440, United States
REXBURG, ID 834402048
Phone: (208) 359-6419
Fax: (208) 356-3111
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $80.
Total Amount is formed as General ($80) + Research ($0) + Ownership ($0) = $80.
Last reported payment date: 2024-05-29 • Largest payer in this snapshot: Stryker Corporation ($80).
Total Amount
$80
General + Research + Ownership
Payments
1
Total payment records
General Amount
$80
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Stryker Corporation | $80 |
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: 2010-07-22
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 |
|---|---|---|---|---|
| I20100722000929 | I | Internal Medicine | 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 |
|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 87 | 45 | $0 |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 84 | 45 | $0 |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes | 59 | 34 | $0 |
| 99305 | Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes | 50 | 47 | $0 |
| 94016 | Test to measure expiratory airflow and volume initiated by patient and evaluated by provider | 41 | 40 | $0 |
Insurance plans in this area (ZIP 83254)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | ID | |
| Nurse Practitioner | ID | |
| Emergency Medicine | ID | |
| Emergency Medicine | IL | |
| Emergency Medicine | IN | |
| Emergency Medicine | ID | |
| - | TX | |
| Internal Medicine | ID | |
| Radiation Oncology | UT | |
| Hematology/Oncology, Internal Medicine, Medical Oncology, Hematology/Oncology | UT |
Reviews
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