Ralph Clark

Primary specialty

DriverTaxonomy code 172A00000X

License

C46272064039 Issued in IL

Practice address

14847 Vail Ave
Harvey, IL 60426-1536

Phone

(773) 724-9433

NPI assigned

Jun 6, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shawn Hines Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1003475880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12003 S PULASKI RD APT 256",
            "city": "ALSIP",
            "state": "IL",
            "postal_code": "608031221",
            "telephone_number": "708-690-3845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14847 VAIL AVE",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604261536",
            "telephone_number": "773-724-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RALPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-06",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "IL",
            "license": "C46272064039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Ralphclark1@outlook.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "none",
            "address_1": "14847 Vail Ave",
            "city": "Harvey",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604261536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHAWN",
            "last_name": "HINES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Driver in Harvey, IL
• Providers in Harvey, IL by specialty
• Driver in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.