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Deactivated NPI 1275578908 Deactivated / Inactive NPI Male Practitioner

Dr. Edwin Merle Clark , MD, FACS, (QME)

Orthopaedic Surgery • Meridian, ID

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Edwin Clark has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date June 17, 2006
NPI Deactivation Date October 17, 2022
Total Practice Duration ~16 Years of Practice (2006 – 2022)

Professional Overview & Biography Verified Profile Summary

Dr. Edwin Clark, MD, FACS, (QME) was a registered Orthopaedic Surgery practicing in Meridian, ID. Throughout an active medical career spanning 16 years, Dr. Clark provided care at the practice location at 360 E MONTVUE DR until profile deactivation on 2022-10-17.

Practice Location & Contact Primary Location

Practice Address

360 E Montvue Dr
Suite 100

Meridian, ID 836426318

Telephone 2088552900
Fax 2088989877
Associated Practice Facility / Clinic
🏢 Spine Institute Of Idaho P A Facility NPI 1659380269

Specialty Benchmarks & Practice Insights

Comparative analytics for Orthopaedic Surgery in Meridian, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 23.0 Yrs
State Avg: 25.4 Yrs
Regional Practice Density
9 Specialists

Practicing in Meridian, ID (168 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Orthopaedic Surgery Primary Specialty

NUCC Taxonomy Code: 207X00000X

State License ID M-6683

An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

10 Associated Practitioners
Sari Lavarias , PA-C

Plastic Surgery

NPI 1033454426

Physician Assistant (Certified)

Scott Ward , PA-C

Physician Assistant

NPI 1053740258

Physician Assistant (Certified)

NPI 1235338682

PHYSICALTHERAPIST

Kalyn Baisley , PA-C

Physician Assistant

NPI 1295163160

Physician Assistant (Certified)

Dr. Michael Spackman , MD

Physical Medicine & Rehabilitation - Pain Medicine

NPI 1386887032

Doctor of Medicine (M.D.)

Dr. Beth Rogers , MD

Physical Medicine & Rehabilitation - Pain Medicine

NPI 1427151539

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated October 17, 2022

Record deactivated on October 17, 2022

NPI Profile Active February 26, 2008

NPI status registered as active in NPPES database

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Updated Practice Location February 26, 2008

Registered at 360 E MONTVUE DR, SUITE 100, MERIDIAN, ID 836426318 (Tel: 2088552900)

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Updated Business Mailing Address February 26, 2008

Registered at 360 E MONTVUE DR, SUITE 100, MERIDIAN, ID 836426318 (Tel: 2088552900)

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Provider Name / Credentials Updated February 26, 2008

Recorded as EDWIN CLARK, M.D., F.A.C.S, (QME)

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 26, 2008

Orthopaedic Surgery (License #M-6683 in ID)

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Initial NPI Registration & Enumeration June 17, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1275578908
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 17, 2006
Last Update: February 26, 2008
Deactivation Date: October 17, 2022

Mailing Address

360 E Montvue Dr, Suite 100

Meridian, ID 836426318

Phone: 2088552900

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.