MICHAEL J CLARK (PA) – Physician Assistant, NPI 1063511921
Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for MICHAEL J CLARK (PA)
Pop in a Box, 800, Avenida Presidente Juscelino Kubitscheck de Oliveira, Jardim Panorama, São José do Rio Preto, Região Imediata de São José do Rio Preto, Região Geográfica Intermediária de São José do Rio Preto, São Paulo, Southeast Region, 15092-450, Brazil
ORLANDO, FL 328628296
Phone: (407) 741-9418
Fax: (904) 346-0113
Type: Mailing
1099, Citrus Tower Boulevard, Clermont, Lake County, Florida, 34711, United States
CLERMONT, FL 347111947
Phone: (352) 394-4071
Fax: (904) 346-0113
Type: Location
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 $22.
Total Amount is formed as General ($22) + Research ($0) + Ownership ($0) = $22.
Last reported payment date: 2023-05-08 • Largest payer in this snapshot: Ethicon US, LLC ($22).
Total Amount
$22
General + Research + Ownership
Payments
1
Total payment records
General Amount
$22
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-05-08
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Ethicon US, LLC | $22 |
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: 2004-05-03
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 |
|---|---|---|---|---|
| I20040503000614 | I | Physician Assistant | FL | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32862)
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Reviews
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