KATIE D CLARK RD, LDN
NPI 1689455594
Dietitian, Registered in Philadelphia, PA
NPI Status: Active since October 09, 2023
Contact Information
1807 WATERLOO ST
PHILADELPHIA, PA
ZIP 19122
Phone: (267) 768-8739
- Individual
- Female
- Dietitian, Registered
- Opted-Out Medicare
About KATIE CLARK
This page provides the complete NPI Profile along with additional information for Katie Clark, a provider established in Philadelphia, Pennsylvania with a medical specialization in Dietitian, Registered. The healthcare provider is registered in the NPI registry with number 1689455594 assigned on October 2023. The practitioner's primary taxonomy code is 133V00000X. The provider is registered as an individual and her NPI record was last updated 2 years ago.
- NPI
- 1689455594
- Provider Name
- KATIE D CLARK RD, LDN
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 1807 WATERLOO ST PHILADELPHIA, PA 19122
- Location Phone
- (267) 768-8739
- Mailing Address
- 1807 WATERLOO ST PHILADELPHIA, PA 19122
- Mailing Phone
- (267) 768-8739
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 10-09-2023
- Last Update Date
- 10-09-2023
- Code Navigator
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Katie Clark opted out of Medicare effective on 05-02-2024 until 05-02-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dietitian, Registered
- Taxonomy Code
- 133V00000X
- Type
- Dietary & Nutritional Service Providers
- Taxonomy Description
- A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
Medicare Participation & PECOS Enrollment Status
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 05-02-2024
Opt-Out End Date: 05-02-2026
Eligible to Order and Refer? No
Reviews for KATIE D CLARK RD, LDN
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 6 | 8 | 9 | 4 | 5 | 5 | 5 | 9 | 4 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 6 | 16 | 9 | 8 | 5 | 10 | 5 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 6 + 1 + 6 + 9 + 8 + 5 + 1 + 0 + 5 + 1 + 8 + 24 = 76 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 76 = 4 | 4 | ||||||||
The NPI number 1689455594 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 3 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1831860816 | DR. JESSE ALLEN SMITH LMFT Individual | Marriage & Family Therapist | 1807 WATERLOO ST PHILADELPHIA, PA 19122 (256) 393-4039 |
| 1093432841 | MIND BELLY SOUL NUTRITION LLC Organization | Clinic/Center (Health Service) | 1807 WATERLOO ST PHILADELPHIA, PA 19122 (678) 656-5830 |
| 1972374585 | DR JESSE SMITH THERAPY LLC Organization | Marriage & Family Therapist | 1807 WATERLOO ST PHILADELPHIA, PA 19122 (484) 278-3319 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1689455594, enumerated in the NPI registry as an "individual" on October 09, 2023
The provider is located at 1807 Waterloo St Philadelphia, Pa 19122 and the phone number is (267) 768-8739
The provider's speciality is Dietitian, Registered with taxonomy code 133V00000X
No, the provider signed an affidavit on May 02, 2024 to opt-out of the Medicare program. The provider is excluded from the Medicare program until May 02, 2026.
This NPI record was last updated on October 09, 2023. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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