Carl F Clavenna, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301054362 Issued in MI

Practice address

600 S Adams Rd
Ste 200
Birmingham, MI 48009-6863

Phone

(248) 646-3733

Fax

(248) 642-2566

NPI assigned

Jun 21, 2005

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 identifiers 6

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

86.83 of 100Reported as group

Quality

96.82

Promoting interoperability

99

Improvement activities

40

Cost

60.09

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carlclavennamd@clavennavision.direct.eyemdemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beaumont Medical Group- Specialty Services

  • Surgery Physician
  • Royal Oak, MI
  • NPI 1578072906
  Medicare reassignment NPD

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1003812561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S ADAMS RD",
            "address_2": "STE 200",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096863",
            "telephone_number": "248-646-3733",
            "fax_number": "248-642-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S ADAMS RD",
            "address_2": "STE 200",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096863",
            "telephone_number": "248-646-3733",
            "fax_number": "248-642-2566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAVENNA",
        "first_name": "CARL",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301054362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "180F321870",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES PIN",
            "identifier": "101441",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP PIN #",
            "identifier": "F48420",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M-CARE ID #",
            "identifier": "C4110",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK GROUP #",
            "identifier": "G5031F",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPOM",
            "identifier": "F48420",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CarlClavennaMD@clavennavision.direct.eyemdemr.com",
            "affiliation": "N",
            "endpointDescription": "EYEMD Emr",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDa",
            "address_1": "600 S Adams Rd",
            "address_2": "Ste 200",
            "city": "Birmingham",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480096863",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• CLC Behavioral Health, PLLC
• Kevin Joseph Clouthier, LPC
• Cloverleaf Transportation, Inc.
• Yvette Cobb, NP

• Ophthalmology Physician in Birmingham, MI
• Providers in Birmingham, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.