Mr Clark Robert Thompson, MA in Fayetteville, AR - Medicare Student in an Organized Health Care Education/Training Program Provider

Mr Clark Robert Thompson, MA is a medicare enrolled "Student In An Organized Health Care Education/training Program" provider in Fayetteville, Arkansas. His current practice location is 86 W Sunbridge Dr, Fayetteville, Arkansas. You can reach out to his office (for appointments etc.) via phone at (479) 435-6360.

Mr Clark Robert Thompson is licensed to practice in * (Not Available) (license number ) 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 1003284274.

Contact Information

	Mr Clark Robert Thompson, MA
	86 W Sunbridge Dr, Fayetteville, AR 72703-1822
	(479) 435-6360
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Mr Clark Robert Thompson
Gender	Male
Speciality	Student In An Organized Health Care Education/training Program
Location	86 W Sunbridge Dr, Fayetteville, Arkansas
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1003284274
Provider Enumeration Date: 09/04/2015
Last Update Date: 10/31/2018

Medicare PECOS Information:

PECOS PAC ID: 2567995731
Enrollment ID: I20241025002539

Medical Identifiers

Medical identifiers for Mr Clark Robert Thompson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1003284274	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103T00000X	Psychologist	1810AP-PL (Arkansas)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	(* (Not Available))	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. Mr Clark Robert Thompson allows following entities to bill medicare on his behalf.

Entity Name	Associated Clinical Psychologists, Ltd
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1578665147 PECOS PAC ID: 4981991031 Enrollment ID: O20160919000110

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. Mr Clark Robert Thompson 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
Mr Clark Robert Thompson, MA 405 Central Ave, Northfield, IL 60093-3006 Ph: (847) 441-5600	Mr Clark Robert Thompson, MA 86 W Sunbridge Dr, Fayetteville, AR 72703-1822 Ph: (479) 435-6360

Mr Clark Robert Thompson, MA - Medicare in Fayetteville, AR