Chad Leroy Clark, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A70662 Issued in CA

Practice address

3865 Jackson St
Riverside, CA 92503-3919

Phone

(951) 352-5666

Fax

(951) 352-5445

NPI assigned

Jun 15, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Anaheim Emergency Medical Group

  • Emergency Medicine Physician
  • Anaheim, CA
  • NPI 1114626017
  Medicare reassignment NPD Authorized official
• Riverside Emergency Physicians Medical Group

  • Emergency Medicine Physician
  • Riverside, CA
  • NPI 1972539039
  Medicare reassignment NPD Authorized official
• Culver Emergency Medical Group

  • Emergency Medicine Physician
  • Culver City, CA
  • NPI 1699907923
  Medicare reassignment NPD
• Chino Emergency Medical Associates

  • Emergency Medicine Physician
  • Chino, CA
  • NPI 1720028525
  NPD (past)
• Melvin a. Ochs, M.D., Medica Corp

  • Emergency Medicine Physician
  • Chula Vista, CA
  • NPI 1538199328
  NPD (past)

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213315200000",
    "number": "1023052545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 661987",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910661987",
            "telephone_number": "626-447-0296",
            "fax_number": "626-447-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3865 JACKSON ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033919",
            "telephone_number": "951-352-5666",
            "fax_number": "951-352-5445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHAD",
        "middle_name": "LEROY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2008-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A70662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A706620",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarity Hearing AIDS & Services
• Stephanie Yvette Clark Rhoe, MSW
• Alexis Nicole Clark, NP
• Arthur Milton Clark Jr.
• Brandi Clark
• Craig Anson Clark, PA-C
• Danielle Clark
• Gary Michael Jesus Clark, CHW
• Isaiah Daniel Clark
• Jaclyn Clark

• Emergency Medicine Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.