NPIMap

Individual provider Active NPI

Carolyn Clark, M.D.

  • Internal Medicine Physician
  • Roanoke, VA
National Provider Identifier
1033156617
Registry record updated Apr 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101057337 Issued in VA
Practice address
4461 Starkey Road
Suite 201
Roanoke, VA 24018
Phone
(540) 345-4946
Fax
(540) 343-7693
NPI assigned
Jun 1, 2006
Last updated
Apr 5, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101057337 VA Primary

Addresses

Primary practice location

4461 Starkey Road
Suite 201
Roanoke, VA 24018

Mailing address

4461 Starkey Road
Suite 201
Roanoke, VA 24018
Phone (540) 345-4946

Other identifiers 6

IdentifierTypeStateIssuer
5427630OtherVAAETNA
7236246OtherVACIGNA
393746OtherVAANTHEM
1033156617MedicaidVA
294398OtherVASOUTHERN HEALTH
110165956OtherVARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100210000611 VA Practitioner - Internal Medicine 2860572997 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Associates of Virginia PCGroup PAC ID 3870578214, 7 clinicians

Practice addresses (Care Compare)

1421 3Rd St SW
Roanoke, VA 24016-5204
Phone (540) 345-4946

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Associates of Virginia PC Internal Medicine CurrentSince Sep 1, 1998 Accepting new patients

Locations

1421 3rd St SW
Roanoke, VA 24016
Phone (540) 345-4946

4461 Starkey Rd
Ste 201
Roanoke, VA 24018
Phone (540) 345-4946

Interoperability endpoints

  • Direct secure messaging: cclark@pav.ssdirect.aprima.com

Organizations & group practices 1

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

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301961600000",
    "number": "1033156617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4461 STARKEY ROAD",
            "address_2": "SUITE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24018",
            "telephone_number": "540-345-4946",
            "fax_number": "540-982-7164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4461 STARKEY ROAD",
            "address_2": "SUITE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24018",
            "telephone_number": "540-345-4946",
            "fax_number": "540-343-7693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CAROLYN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2011-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101057337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5427630",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7236246",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "393746",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033156617",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "294398",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110165956",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.