Adam Clark, LCSW - Medicare Clinical Social Worker in Coquille, OR

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Adam Clark, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Coquille, Oregon. His current practice location is 790 E 5th St, Coquille, Oregon. You can reach out to his office (for appointments etc.) via phone at (541) 396-3111.

Adam Clark is licensed to practice in Oregon (license number L8122) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1699276287.

Contact Information

Adam Clark, LCSW
790 E 5th St,
Coquille, OR 97423-1755
(541) 396-3111
Not Available

Map and Direction




Healthcare Provider's Profile

Full NameAdam Clark
GenderMale
SpecialitySocial Worker - Clinical
Location790 E 5th St, Coquille, Oregon
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1699276287
  • Provider Enumeration Date: 02/28/2018
  • Last Update Date: 09/03/2020
  Medicare PECOS Information:
  • PECOS PAC ID: 8426481839
  • Enrollment ID: I20191125002098

Medical Identifiers

Medical identifiers for Adam Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1699276287NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
1041C0700XSocial Worker - Clinical CSW.09924908 (Colorado)Secondary
1041C0700XSocial Worker - Clinical L8122 (Oregon)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Adam Clark allows following entities to bill medicare on his behalf.
Entity NameWaterfall Clinic Incorporated
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1619915113
PECOS PAC ID: 5698740355
Enrollment ID: O20040827000153
Entity NameVista Counseling & Consultation Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1275864985
PECOS PAC ID: 1153748363
Enrollment ID: O20200902002946

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Adam Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Adam Clark, LCSW
940 E 5th St,
Coquille, OR 97423-1699

Ph: (541) 396-3101		Adam Clark, LCSW
790 E 5th St,
Coquille, OR 97423-1755

Ph: (541) 396-3111

Reviews and Comments


Social Worker in Coquille, OR

Marne Potocki,
Clinical Social Worker
Medicare: Not Enrolled in Medicare
Practice Location: 1582 N Elliott St, Coquille, OR 97423
Phone: 248-752-5114    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.