MR. DEREK CLARK (NPI# 1497161590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497161590 |
| Entity Type | Individual |
| Full Name | MR. DEREK CLARK |
| Credential | BOCO C.PED |
| Practice Address |
5111 Juan Tabo Blvd Ne Ste A Albuquerque NM 87111 |
| Practice Telephone | 5052009004 |
| Practice Fax Number | 5052710217 |
| Mailing Telephone | 5052009004 |
| Mailing Fax Number | 5052710217 |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2014-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Z00000X | Orthotist | C49914 | MD | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083156061 | Derek Clark | Physical Therapist | 6349 Garners Ferry Rd, Columbia, SC 29209 | 2016-11-08 |
| 1487070942 | Derek Clark | Specialist/Technologist | 625 Beaver St, Leetsdale, PA 15056-1200 | 2014-03-07 |
| 1124452073 | Derek Clark | Pharmacist | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2013-08-28 |
| 1518283589 | Derek William Clark | Psychiatry & Neurology | 500 17th Ave, Seattle, WA 98122-5711 | 2010-04-15 |
| 1902059843 | Derek Dwight Clark | Physical Therapist | 116 Market St, Mannington, WV 26582-1131 | 2008-10-23 |
| Street Address |
5111 JUAN TABO BLVD NE STE A |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87111 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356347835 | Sharon Walston Kobos | Podiatrist | 5111 Juan Tabo Blvd Ne, Albuquerque, NM 87111-2672 | 2005-06-21 |
| 1124413836 | Sara Elizabeth Grzywa | Podiatrist | 5111 Juan Tabo Blvd Ne, Albuquerque, NM 87111-2672 | 2015-03-31 |
| 1386999365 | New Mexico Foot and Ankle Centers LLC | Podiatrist | 5111 Juan Tabo Blvd Ne, Albuquerque, NM 87111-2672 | 2012-07-17 |
| 1205112497 | New Mexico Foot & Ankle Centers PC | Podiatrist | 5111 Juan Tabo Blvd Ne, Albuquerque, NM 87111-2672 | 2011-11-01 |
| 1912048711 | Foot & Ankle Specialists of New Mexico PC | Durable Medical Equipment & Medical Supplies | 5111 Juan Tabo Blvd Ne, Albuquerque, NM 87111-2672 | 2007-02-12 |
| 1891705794 | Chad Brady | Podiatrist | 5111 Juan Tabo Blvd Ne, Albuquerque, NM 87111-2672 | 2006-08-09 |
| 1407879703 | Brent Frame | Podiatrist | 5111 Juan Tabo Blvd Ne, Albuquerque, NM 87111-2672 | 2006-07-26 |
| 1790744951 | Jason Boyd Dodder | Podiatrist | 5111 Juan Tabo Blvd Ne, Albuquerque, NM 87111-2672 | 2006-03-17 |
| 1447248000 | Steven S Wrege | Podiatrist | 5111 Juan Tabo Blvd Ne, Albuquerque, NM 87111-3971 | 2005-10-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417438110 | Dehlen LLC | Counselor | 11000 Spain Rd Ne, Building E, Albuquerque, NM 87111 | 2018-08-22 |
| 1003313008 | Jessika Junick | Nurse Practitioner | 3825 Eubank Blvd Ne Ste A, Albuquerque, NM 87111 | 2018-04-07 |
| 1881113454 | Hayley Aragon-bell | Day Training/Habilitation Specialist | 3732 Mount Rainier Dr. Ne, Albuquerque, NM 87111 | 2017-09-14 |
| 1750803326 | Sarah Mckenzie Ochoa | Day Training/Habilitation Specialist | 3916 Garcia St Ne, Albuquerque, NM 87111 | 2017-07-14 |
| 1285179549 | Family Dental Health Care | Dentist | 4550 Eubank Blvd, Suite 203, Albuquerque, NM 87111 | 2016-12-22 |
| 1871036202 | Shobha Jagannath | Nurse Practitioner | 10700 Academy Rd Ne Apt 216, Albuquerque, NM 87111 | 2016-12-03 |
| 1508319310 | Mariana Boitano | Licensed Practical Nurse | 5400 Gibson Blvd., Albuquerque, NM 87111 | 2016-07-28 |
| 1184011082 | Adam Halpern | Specialist/Technologist | 4204 Parsifal St, Albuquerque, NM 87111 | 2015-04-20 |
| 1083015770 | Cvs Pharmacy | Public Health or Welfare | 5516 Camino Arbustos Ne, Albuquerque, NM 87111 | 2014-09-12 |
| 1508276973 | Stephanie Gonzales | Physician Assistant | 12241 Academy Rd Ne Ste 204, Albuquerque, NM 87111 | 2014-05-06 |
| Find all providers in zip 87111 | ||||
| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316211238 | Ahmahn M Peeples | Orthotist | 1904 Wellspring Ave Se, Suite 109, Rio Rancho, NM 87124-4791 | 2012-02-24 |
| 1700022019 | Frederick Paul Coen | Orthotist | 2516 Camino San Patricio, Santa Fe, NM 87505 | 2008-12-17 |
| 1730323973 | Vicror Rivera Jr. | Orthotist | 2530 S Telshor Blvd, Suite 107, Las Cruces, NM 88011-4907 | 2009-04-30 |
| 1700896784 | Steinmann Enterprises Inc. | Orthotist | 3885 Foothills Rd, Suite 1, Las Cruces, NM 88011-4672 | 2006-08-09 |
| City | ALBUQUERQUE |
| Zip Code | 87111 |
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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.