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Deactivated NPI 1346343944 Deactivated / Inactive NPI Male Practitioner

Dr. Michael E Clark , DPM

Podiatrist • Decatur, IL

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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. Michael Clark has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 07, 2006
NPI Deactivation Date July 12, 2023
Total Practice Duration ~17 Years of Practice (2006 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Michael Clark, DPM was a registered Podiatrist practicing in Decatur, IL. Throughout an active medical career spanning 17 years, Dr. Clark provided care at the practice location at 102 W KENWOOD AVE until profile deactivation on 2023-07-12.

Historical Medicare Part B clinical services included removal of fingernails or toenails, established patient outpatient office visit, removal of single thickened skin growth. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

102 W Kenwood Ave
Ste 160

Decatur, IL 62526

Telephone 2178770444
Fax 2178774347
Associated Practice Facility / Clinic
🏢 Decatur Memorial Hospital Facility NPI 1437246865

Specialty Benchmarks & Practice Insights

Comparative analytics for Podiatrist in Decatur, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 27.0 Yrs
State Avg: 29.2 Yrs
Regional Practice Density
3 Specialists

Practicing in Decatur, IL (647 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
38.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2019)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
11721 Removal of fingernails or toenails, 6 or more nails
75 75 $70.00 $43.48
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more
71 54 $80.00 $42.88
11055 Removal of single thickened skin growth
18 18 $80.00 $52.53
99202 New patient office or other outpatient visit, typically 20 minutes
13 13 $115.00 $73.40

Medical Specialties & State Licenses

Podiatrist Primary Specialty

NUCC Taxonomy Code: 213E00000X

State License IL 016002692

A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

Practice Associates & Co-Workers

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

21 Associated Practitioners
Virginia Kerwin , RD, CDE, LDN

Dietitian, Registered

NPI 1023160728

Registered Dietitian, Certified Diabetes Educator, Licensed Dietitian Nutritionist

Brooklynn Aldridge

Community Health Worker

NPI 1124818125
Dr. Robyn Ploessl , DPT

Physical Therapist

NPI 1205190428

Doctor of Physical Therapy

Michael Koch , MS, ATC

Specialist/Technologist - Athletic Trainer

NPI 1235105404

Master of Science, Certified Athletic Trainer

Tammy Munch , PA-C

Physician Assistant

NPI 1285713768

Physician Assistant (Certified)

Kylie Vandyke

Social Worker - Clinical

NPI 1346069432

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 July 12, 2023

Record deactivated on July 12, 2023

NPI Profile Active May 09, 2011

NPI status registered as active in NPPES database

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Updated Practice Location May 09, 2011

Registered at 102 W KENWOOD AVE, STE 160, DECATUR, IL 62526 (Tel: 2178770444)

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Updated Business Mailing Address May 09, 2011

Registered at 102 W KENWOOD AVE, STE 160, DECATUR, IL 62526 (Tel: 2178770444)

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Provider Name / Credentials Updated May 09, 2011

Recorded as MICHAEL CLARK, DPM

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 09, 2011

Podiatrist (License #016002692 in IL)

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Initial NPI Registration & Enumeration September 07, 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: 1346343944
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 07, 2006
Last Update: May 09, 2011
Deactivation Date: July 12, 2023

Mailing Address

102 W Kenwood Ave, Ste 160

Decatur, IL 62526

Phone: 2178770444

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.