Susan B. Clark, MS, RD, LD, CDE
NPI 1124676663ActiveIndividual· Dietitian, Registered· Rexburg, ID
Dietitian, Registered (MS, RD, LD, CDE) in Rexburg, Idaho, licensed in ID, with an NPI issued in August 2019. Enrolled in Medicare as practitioner - registered dietitian or nutrition professional.
Overview
| NPI | 1124676663 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | MS, RD, LD, CDE |
| Sole proprietor | No |
| NPI issued | Aug 28, 2019 |
| Last updated in NPPES | Nov 24, 2025 |
| Certified by provider | Nov 24, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dietitian, Registered Primary | 133V00000X | D-393 | ID |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Registered Dietitian Or Nutrition Professional (ID) |
|---|
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