Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1033108014 Deactivated / Inactive NPI Male Practitioner

Michael Dean Clark , PA-C

Physician Assistant • Racine, WI

⚠️

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

Registration / Start Date October 21, 2005
NPI Deactivation Date June 04, 2026
Total Practice Duration ~21 Years of Practice (2005 – 2026)

Professional Overview & Biography Verified Profile Summary

Michael Clark, PA-C was a registered Physician Assistant practicing in Racine, WI. Throughout an active medical career spanning 21 years, Michael Clark provided care at the practice location at 3805B SPRING ST until profile deactivation on 2026-06-04.

Historical Medicare Part B clinical services included emergency department visit for life threatening or functioning severity, emergency department visit with moderate level of medical decision making, emergency department visit with low level of medical decision making. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

3805b Spring St

Racine, WI 534051641

Telephone 2626874201
Associated Practice Facility / Clinic
🏢 Bruce A Luccas, Md, Llc Facility NPI 1023204963

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Racine, WI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 15.3 Yrs
State Avg: 14.1 Yrs
Regional Practice Density
18 Specialists

Practicing in Racine, WI (3517 Statewide)

Telehealth Adoption Rate
11.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
84.7% 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 (2017)
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99285 Emergency department visit for life threatening or functioning severity
109 103 $876.42 $138.29
99284 Emergency department visit with moderate level of medical decision making
52 51 $586.00 $95.27
99283 Emergency department visit with low level of medical decision making
23 21 $394.74 $50.21

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License WI 420-023

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

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

4 Associated Practitioners
Ryan Beine , PA-C

Physician Assistant

NPI 1104856376

Physician Assistant (Certified)

Dr. Joseph Humphrey , MD

Emergency Medicine

NPI 1477610434

Doctor of Medicine (M.D.)

Lisa Volz , APN

Nurse Practitioner - Family

NPI 1578964151

Advanced Practice Nurse

Samantha Doty , PA-C

Physician Assistant

NPI 1639527989

Physician Assistant (Certified)

Career & Practice History Timeline

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

7 Historical Events
⚠️
NPI Profile Deactivated June 04, 2026

Record deactivated on June 04, 2026

NPI Profile Active May 07, 2013

NPI status registered as active in NPPES database

📍
Updated Practice Location May 07, 2013

Registered at 3805B SPRING ST, RACINE, WI 534051641 (Tel: 2626874201)

📍
Updated Business Mailing Address May 07, 2013

Registered at 2629 FOX RIVER PKWY, WAUKESHA, WI 531897876 (Tel: 2625211674)

👤
Provider Name / Credentials Updated May 07, 2013

Recorded as MICHAEL CLARK, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 07, 2013

Physician Assistant (License #420-023 in WI)

🟢
Initial NPI Registration & Enumeration October 21, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Michael Clark. Be the first to share your experience!

Sign in to leave a review for Michael Clark

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1033108014
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 21, 2005
Last Update: May 07, 2013
Deactivation Date: June 04, 2026

Mailing Address

2629 Fox River Pkwy

Waukesha, WI 531897876

Phone: 2625211674

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.