Adam Clark, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Coquille, Oregon. He graduated from medical school in 2014 and has 11 years of diverse experience with area of expertise as Clinical Social Worker. He is a member of the group practice Waterfall Clinic Incorporated and 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
may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1699276287.
Healthcare Provider's Profile
| Full Name | Adam Clark |
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| Gender | Male |
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| Speciality | Clinical Social Worker |
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| Experience | 11 Years |
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| Location | 790 E 5th St, Coquille, Oregon |
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| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Adam Clark graduated from medical school in 2014
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.
| Identifier | Type | State | Issuer |
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| 1699276287 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1041C0700X | Social Worker - Clinical | CSW.09924908 (Colorado) | Secondary |
| 1041C0700X | Social Worker - Clinical | L8122 (Oregon) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Waterfall Clinic Incorporated | 5698740355 | 23 |
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 Name | Waterfall Clinic Incorporated |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1619915113
PECOS PAC ID: 5698740355
Enrollment ID: O20040827000153 |
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| Entity Name | Vista Counseling & Consultation Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1275864985
PECOS PAC ID: 1153748363
Enrollment ID: O20200902002946 |
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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. 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 Address | Practice Location Address |
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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 |
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