Gary Wayne Clark, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

011418 Issued in OH

Practice address

125 Canton Rd NW
Carrollton, OH 44615-1009

Phone

(330) 627-7641

Fax

(330) 627-5796

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Family Practice

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cleveland Clinic Mercy HospitalGroup PAC ID 0547156796, 92 clinicians

Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Medical Center Hospital, Canton, OH, CCN 360070

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Cleveland Clinic Mercy Hospital

  • General Acute Care Hospital
  • Canton, OH
  • NPI 1366433195
  Medicare reassignment Care Compare group NPD
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cleveland Clinic Mercy Hospital

  • General Acute Care Hospital
  • Canton, OH
  • NPI 1366433195
  Care Compare affiliation

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429833600000",
    "number": "1013987759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 5TH ST NE",
            "city": "CARROLLTON",
            "state": "OH",
            "postal_code": "446151214",
            "telephone_number": "330-627-3494",
            "fax_number": "330-627-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 CANTON RD NW",
            "city": "CARROLLTON",
            "state": "OH",
            "postal_code": "446151009",
            "telephone_number": "330-627-7641",
            "fax_number": "330-627-5796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GARY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2015-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "DO785",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "011418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrollton Chiropractic Center Inc
• Carrollton Exempted Village School District
• Reva Castelucci
• Centreville Village of Carroll County
• Erick C Chamblee, DDS
• Kimberly L Clark
• Cleveland Clinic Mercy Hospital
• Cleveland Clinic Mercy Hospital
• Cleveland Clinic Mercy Hospital
• Coldar

• Family Medicine Physician in Carrollton, OH
• Providers in Carrollton, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; 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.