Susan B Clark, MS, RD, LD, CDE is a medicare enrolled "Dietitian, Registered" provider in Rexburg, Idaho. She graduated from medical school in 2017 and has 7 years of diverse experience with area of expertise as Registered Dietitian Or Nutrition Professional. She is a member of the group practice Madison Co Memorial Hospital and her current practice location is
450 E Main St, Rexburg, Idaho. You can reach out to her office (for appointments etc.) via phone at
(208) 359-6522.
Susan B Clark is licensed to practice in Idaho (license number D-393) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1124676663.
Healthcare Provider's Profile
| Full Name | Susan B Clark |
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| Gender | Female |
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| Speciality | Registered Dietitian Or Nutrition Professional |
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| Experience | 7 Years |
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| Location | 450 E Main St, Rexburg, Idaho |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Susan B Clark graduated from medical school in 2017
NPI Data:
- NPI Number: 1124676663
- Provider Enumeration Date: 08/28/2019
- Last Update Date: 08/28/2019
Medicare PECOS Information:
- PECOS PAC ID: 3476980053
- Enrollment ID: I20200318001657
Medical Identifiers
Medical identifiers for Susan B Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1124676663 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 133V00000X | Dietitian, Registered | D-393 (Idaho) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Madison Co Memorial Hospital | 8123016367 | 24 |
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. Susan B Clark allows following entities to bill medicare on her behalf.
| Provider Name | Madison Co Memorial Hospital |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1134592017
PECOS PAC ID: 8123016367
Enrollment ID: O20040505000664 |
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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. Susan B 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 Address | Practice Location Address |
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Susan B Clark, MS, RD, LD, CDE
450 E Main St,
Rexburg, ID 83440-2048
Ph: (208) 359-6522 | Susan B Clark, MS, RD, LD, CDE
450 E Main St,
Rexburg, ID 83440-2048
Ph: (208) 359-6522 |
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