CAROLYN MAE CLARK (M.D.) – Emergency Medicine Physician, NPI 1497155220

CAROLYN MAE CLARK (M.D.) is a healthcare provider. based in Overland park, Kansas. specializing in EMERGENCY MEDICINE. They hold the professional credentials M.D.. They hold a License No. 04-42111 (KS). The NPI Number for CAROLYN MAE CLARK (M.D.) is 1497155220

Main info

Female
Sole Proprietor
12 Years Of Experience
Accepts Medicare Assignment
Name
CAROLYN MAE CLARK (M.D.)
NPI
1497155220
Phone
(913) 498-6623
Address
5721 W 119TH ST
Enumeration Date
29 August 2014
Last Update Date
13 August 2020

Doctor Profile

Medical School Name
UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
Secondary Phone
9134986000
Graduation Year
2014 (12 years ago)
PAC ID
9234425778
Group Practice PAC ID
4385009695
Professional Enrollment ID
I20190822000226
Address ID
KS662093722OV5721XSTXX431
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience51
Completeness75
Years active:11State licenses:1Digital endpointsOther names

452 EMERGENCY MEDICINE in KS

Provider Addresses for CAROLYN MAE CLARK (M.D.)

  • 5721 W 119TH ST

    OVERLAND PARK, KS 662093753

    Phone: (913) 498-6623

    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: 2019-08-22

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

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

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20190822000226IEmergency MedicineKSTBD

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
99285Emergency department visit with high level of medical decision making257246$0
99284Emergency department visit with moderate level of medical decision making210194$0
99283Emergency department visit with low level of medical decision making4744$0
99291Critical care, first 30-74 minutes4140$0
View full utilization report →

Insurance plans in this area (ZIP 66209)

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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: 4385009695View full group profile
NameSpecialtyState
Emergency MedicineKS
Emergency MedicineNY
Emergency MedicineIL
Nurse PractitionerKS
Emergency MedicineNC
Emergency MedicineMO
Emergency MedicineMO
Emergency MedicineKS
Emergency MedicineIA
Emergency MedicineFL

Reviews

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Frequently asked questions

What is the 10-digit NPI for CAROLYN MAE CLARK (M.D.)?
CAROLYN MAE CLARK (M.D.) — NPI 1497155220 — is the standard way to identify this listing.
Does the file indicate CAROLYN MAE CLARK (M.D.) is practicing under active NPI?
Directory data currently reports CAROLYN MAE CLARK (M.D.) as active.
What taxonomy line describes CAROLYN MAE CLARK (M.D.)?
For research purposes, treat CAROLYN MAE CLARK (M.D.) as Emergency Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for CAROLYN MAE CLARK (M.D.)?
CAROLYN MAE CLARK (M.D.)'s geographic hint is Overland Park, Kansas in our summary view.
Is the information about CAROLYN MAE CLARK (M.D.) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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