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Active NPI 1134539091 Individual Practitioner Male Practitioner

Dr. Kellan Fitzgerald Clark , DO

Urology • Hamilton, MT

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Kellan Clark, DO is a certified Urology practicing in Hamilton, MT. With approximately 12 years of clinical experience since graduating from Edward Via Col Of Osteo Medicine-Carolinas Campus in 2014, Dr. Clark delivers high-quality medical care to the local community at 1200 WESTWOOD DR STE F.

Dr. Clark is affiliated with Marcus Daly Memorial Hospital Corporation and accepts Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

1200 Westwood Dr Ste F

Hamilton, MT 598402345

Telephone 4063752930
Fax 4063754525
Associated Practice Facility / Clinic

Medicare Profile & Education

Medical School

Edward Via Col Of Osteo Medicine-Carolinas Campus

Graduation Year

2014

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Urology in Hamilton, MT

Established Specialist (10-20 Yrs)
Practitioner Clinical Experience
12 Yrs Matches City Avg
City Avg: 12.0 Yrs
State Avg: 22.5 Yrs
Regional Practice Density
1 Specialists

Practicing in Hamilton, MT (57 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

Clinical Seniority & Experience Comparison

Dr. Clark (12 Years) 12 Yrs
Hamilton Specialty Average (12.0 Years) 12.0 Yrs

Medical Specialties & State Licenses

CMS Verified: 2024-11-12
Urology Primary Specialty

NUCC Taxonomy Code: 208800000X

State License MT MED-PHYS-LIC-71931

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
1134539091 (ID)
Medicaid State Provider ID
100004016 (MT)

Hospital & Practice Group Affiliations

Marcus Daly Memorial Hospital Corporation

3975 Us Hwy 93 N, Stevensville, MT 598706474

Phone: 4067776002

Practice Associates & Co-Workers

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

2 Associated Practitioners
NPI 1366495251

Doctor of Medicine (M.D.)

NPI 1508270786

Doctor of Medicine (M.D.)

Career & Practice History Timeline

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

13 Historical Events
📍
Updated Practice Location November 12, 2024

Registered at 1200 WESTWOOD DR STE F, HAMILTON, MT 598402345 (Tel: 4063752930)

👤
Provider Name / Credentials Updated November 12, 2024

Recorded as KELLAN CLARK, DO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 12, 2024

Urology (License #MED-PHYS-LIC-71931 in MT)

📍
Updated Business Mailing Address May 12, 2021

Registered at 1200 WESTWOOD DR, HAMILTON, MT 598402345

📍
Updated Practice Location October 07, 2019

Registered at 215 N 10TH ST STE A, HAMILTON, MT 598402328 (Tel: 4063752930)

📍
Updated Business Mailing Address October 07, 2019

Registered at 1224 W MAIN ST, HAMILTON, MT 598402338 (Tel: 4063754824)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 07, 2019

Urology (License #71931 in MT)

NPI Profile Active April 30, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location April 30, 2014

Registered at 3110 MACCORKLE AVE SE, CHARLESTON, WV 253041210 (Tel: 3043885590)

📍
Updated Business Mailing Address April 30, 2014

Registered at 3110 MACCORKLE AVE SE, CHARLESTON, WV 253041210 (Tel: 3043885590)

👤
Provider Name / Credentials Updated April 30, 2014

Recorded as KELLAN CLARK, D.O.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 30, 2014

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration April 30, 2014

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: 1134539091
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 30, 2014
Last Update: November 12, 2024
Sole Proprietor: No

Mailing Address

1200 Westwood Dr

Hamilton, MT 598402345

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.