JOHN B CLARK JR. (NPI# 1003866443) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003866443 |
| Entity Type | Individual |
| Full Name | JOHN B CLARK JR. |
| Credential | M.D. |
| Practice Address |
1900 Randolph Rd Ste 900 Charlotte NC 28207-1106 |
| Practice Telephone | 7043772424 |
| Practice Fax Number | 7043772687 |
| Mailing Telephone | 7043772424 |
| Mailing Fax Number | 7043772687 |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2007-10-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 23260 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 89-22664 | 05 | |
| SC | N23260 | 05 | |
| NC | BCBSNC | 22664 | 01 |
| NC | RR MEDICARE | 930067545 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245890672 | John Douglas Clark Jr. | Family Medicine | 54 Meadowbrook Cir, Brevard, NC 28712-8543 | 2019-06-18 |
| 1063072973 | John Riley Clark | Physician Assistant | 2700 Light Rd Apt 102, Oswego, IL 60543-9231 | 2019-06-13 |
| 1871909986 | John Clark | Internal Medicine | 740 Bethlehem Pike, Flourtown, PA 19031-1318 | 2014-07-09 |
| 1831444017 | John Arnot Clark | Dermatology | 1849 Mission Ridge Road, Santa Barbara, CA 93103-1857 | 2012-07-13 |
| 1427327428 | John Jacob Clark | Pharmacist | 1312 Northland Drive, Mendota Heights, MN 55120 | 2011-12-20 |
| 1841580586 | John Alan Clark | Pharmacist | 1900 Argillite Rd, Flatwoods, KY 41139-1616 | 2011-04-14 |
| 1740586932 | John Casey Clark | Occupational Therapist | 448 Lewis Hargett Cir, Suite 100, Lexington, KY 40503-3594 | 2011-02-04 |
| 1023327921 | John M Clark | Social Worker | 3528 Manchester Rd, Wantagh, NY 11793-3010 | 2010-09-27 |
| 1831417922 | John Russell Clark | Speech-Language Pathologist | 7811 Cobden Rd, Laverock, PA 19038-7257 | 2010-05-13 |
| 1518151513 | John M Clark | Physical Therapist | 1202 Se 6th St, Wagoner, OK 74467-6316 | 2007-09-02 |
| Street Address |
1900 RANDOLPH RD STE 900 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28207-1106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881689362 | Barbara Elizabeth Kissam | Pediatrics | 1900 Randolph Rd, Suite 1010, Charlotte, NC 28207-1122 | 2005-09-12 |
| 1144769332 | Courtney Wiseman | Physician Assistant | 1900 Randolph Rd, Suite 800, Charlotte, NC 28207-1122 | 2017-02-21 |
| 1700339785 | Yu Wei Shan | Nurse Practitioner | 1900 Randolph Rd, Suite 800, Charlotte, NC 28207-1122 | 2016-07-26 |
| 1891182127 | Novant Medical Group,inc | Pediatrics | 1900 Randolph Rd, Suite 300, Charlotte, NC 28207-1122 | 2015-04-24 |
| 1578979936 | Kristen Elizabeth Bush | Physician Assistant | 1900 Randolph Rd, Ste 900, Charlotte, NC 28207-1122 | 2014-07-07 |
| 1003235524 | Novant Medical Group Inc | Internal Medicine | 1900 Randolph Rd, Suite 216, Charlotte, NC 28207-1122 | 2014-04-11 |
| 1508107863 | Novant Medical Group Inc | Internal Medicine | 1900 Randolph Rd, Suite 300, Charlotte, NC 28207-1106 | 2013-03-12 |
| 1639422264 | Anthony James Mignanelli II | Nurse Practitioner | 1900 Randolph Rd, Suite 900, Charlotte, NC 28207-1122 | 2012-10-19 |
| 1851642169 | Meagan Marie Bullock | Social Worker | 1900 Randolph Rd, Suite 800, Charlotte, NC 28207-1122 | 2012-09-26 |
| 1114299294 | Worley Shaun Lynch | Physician Assistant | 1900 Randolph Rd, Suite 900, Charlotte, NC 28207-1122 | 2012-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013560739 | Louis Roncaglione | Dentist | 8815 Christenbury Pkway, Concord, NC 28207 | 2019-07-22 |
| 1619430014 | Khrystyna Levytska | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Ob/gyn, 1350 S. Kings Dr., Charlotte, NC 28207 | 2019-04-11 |
| 1649743584 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 1005 South Kings Drive, Charlotte, NC 28207 | 2019-01-03 |
| 1023584489 | Herron and Smith Associates, Pllc | Dentist | 135 Perrin Place, Suite 100, Charlotte, NC 28207 | 2018-10-23 |
| 1588161640 | Lauren Mogk | Student in an Organized Health Care Education/Training Program | Myers Park Clinical Internal Medicine, 1350 S. Kings Dr., 3rd Floor, Charlotte, NC 28207 | 2018-04-06 |
| 1518462241 | Sarah Hollyn Carlock | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Internal Medicine, 1350 S Kings Dr, 3rd Floor, Charlotte, NC 28207 | 2018-03-26 |
| 1083118178 | Claire Milam | Student in an Organized Health Care Education/Training Program | Cmc/department of Emergency Medicine, 100 Blythe Blvd, Charlotte, NC 28207 | 2018-03-22 |
| 1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
| 1063945467 | Kaitlyn O'keefe | Internal Medicine | 1350 S. Kings Dr., 3rd Floor, Myers Park Clinic Internal Medicine, Charlotte, NC 28207 | 2017-04-04 |
| 1811432024 | Advanced Prosthetics of Easley, Inc | Durable Medical Equipment & Medical Supplies | 2310 Randolph Rd Ste A, Charlotte, NC 28207 | 2016-12-23 |
| Find all providers in zip 28207 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164021051 | Onespotmd Primary and Urgent Care Pllc | Emergency Medicine | 2017 Central Ave Ste 103, Charlotte, NC 28205-5388 | 2020-10-21 |
| 1750909032 | The Presbyterian Hospital | Emergency Medicine | 125 Queens Rd Ste 500, Charlotte, NC 28204-3215 | 2020-07-13 |
| 1982225983 | William Bedard Michel | Emergency Medicine | Carolina Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203 | 2020-04-30 |
| 1457988586 | Morgan Mazakas Penzler | Emergency Medicine | 1000 Blythe Blvd Ste 600, Charlotte, NC 28203-5812 | 2020-03-26 |
| 1538620737 | Andrew Yde | Emergency Medicine | Cmc/department of Emergency Medicine, 1000 Blythe Blvd., Charlotte, NC 28203-5812 | 2019-03-29 |
| 1780048348 | Cornelius Powell IIi | Emergency Medicine | Gme1000 Blythe Blvd., Meb, Suite 157, Carolinas Medical Center, Charlotte, NC 28203-2861 | 2016-04-11 |
| 1417185125 | Anil Kumar Chhabra | Emergency Medicine | 14714 Jockeys Ridge Dr, Charlotte, NC 28277-3717 | 2009-07-01 |
| 1669608709 | Anthony L Fox | Emergency Medicine | 8800 N Tyron St, Carolinas Medical Center -university, Charlotte, NC 28262 | 2009-06-03 |
| 1821250697 | Christopher Kirt Kessler | Emergency Medicine | 1133 Metropolitan Ave Unit 618, Charlotte, NC 28204-3401 | 2008-07-01 |
| 1265606784 | Michael Craig Flanders | Emergency Medicine | 8800 North Tryon St, Emp, Charlotte, NC 28262 | 2008-04-16 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.