NPIMap

Individual provider Active NPI

Clyde Whitley Vick III, MD

  • Diagnostic Radiology Physician
  • Jacksonville, FL
National Provider Identifier
1003976648
Registry record updated Mar 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
028094 Issued in GA
Practice address
1833 Boulevard
Jacksonville, FL 32206-4382
Phone
(904) 232-2751
Fax
(904) 232-2482
NPI assigned
Dec 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2012

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X 028094 GA
Neuroradiology Physician 2085N0700X 028094 GA
Nuclear Radiology Physician 2085N0904X 028094 GA
Pediatric Radiology Physician 2085P0229X 028094 GA
Diagnostic Radiology Physician 2085R0202X 028094 GA Primary
Vascular & Interventional Radiology Physician 2085R0204X 028094 GA
Diagnostic Ultrasound Physician 2085U0001X 028094 GA

Addresses

Primary practice location

1833 Boulevard
Jacksonville, FL 32206-4382

Mailing address

1833 Boulevard
Jacksonville, FL 32206-4382
Phone (904) 232-2751

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
028094GAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Harbin Clinic, LLC Past Accepting new patients
Rome Imaging Associates Nuclear Radiology Past Accepting new patients
Rome Radiology Group, PA Body Imaging Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331596800000",
    "number": "1003976648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 BOULEVARD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322064382",
            "telephone_number": "904-232-2751",
            "fax_number": "904-232-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 BOULEVARD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322064382",
            "telephone_number": "904-232-2751",
            "fax_number": "904-232-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICK",
        "first_name": "CLYDE",
        "middle_name": "WHITLEY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2012-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "GA",
            "license": "028094",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "GA",
            "license": "028094",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "GA",
            "license": "028094",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "GA",
            "license": "028094",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "028094",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "GA",
            "license": "028094",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "GA",
            "license": "028094",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; 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.