Dr Theresa L Clark, MD is a medicare enrolled "Psychiatry & Neurology - Psychiatry" physician in Dillon, Colorado. She graduated from medical school in 2007 and has 17 years of diverse experience with area of expertise as Psychiatry. Her current practice location is
114 Village Place, St 207, Dillon, Colorado. You can reach out to her office (for appointments etc.) via phone at
(970) 455-9004.
Dr Theresa L Clark is licensed to practice in Colorado (license number DR.0061413) 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 1104015155.
Physician's Profile
| Full Name | Dr Theresa L Clark |
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| Gender | Female |
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| Speciality | Psychiatry |
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| Experience | 17 Years |
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| Location | 114 Village Place, Dillon, Colorado |
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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:
- Dr Theresa L Clark graduated from medical school in 2007
NPI Data:
- NPI Number: 1104015155
- Provider Enumeration Date: 10/16/2007
- Last Update Date: 04/14/2021
Medicare PECOS Information:
- PECOS PAC ID: 2062680010
- Enrollment ID: I20190501000062
Medical Identifiers
Medical identifiers for Dr Theresa L Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1104015155 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 2084P0800X | Psychiatry & Neurology - Psychiatry | 35.135479 (Ohio) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME104695 (Florida) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | TRN11797 (Florida) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | DR.0061413 (Colorado) | Primary |
Medical Facilities Affiliation
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. Dr Theresa L Clark allows following entities to bill medicare on her behalf.
| Entity Name | Denver Health And Hospital Authority |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1477569838
PECOS PAC ID: 4688583578
Enrollment ID: O20031105000211 |
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| Entity Name | Ten Mile Health & Wellness Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1417538281
PECOS PAC ID: 9032528393
Enrollment ID: O20210518000039 |
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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. Dr Theresa L 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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Dr Theresa L Clark, MD
Po Box 2098,
Dillon, CO 80435-2098
Ph: (970) 455-9004 | Dr Theresa L Clark, MD
114 Village Place, St 207,
Dillon, CO 80435
Ph: (970) 455-9004 |
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