Charles H Clark III, MD

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

9666 Issued in AL

Practice address

800 St Vincents Drive
#700
Birmingham, AL 35205

Phone

(205) 933-8981

Fax

(205) 930-0746

NPI assigned

Oct 10, 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 AL

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

Networks

• bcbs alabama network 01E0
• bcbs alabama network 01I0
• bcbs alabama network 01H0
• bcbs alabama network 01G0
• bcbs alabama network 01A0
• bcbs alabama network 01B0

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.

• Neurosurgical Associates, P. C.

  • Neurological Surgery Physician
  • Birmingham, AL
  • NPI 1700941317
  Medicare reassignment NPD
• Vestavia Hills Imaging Center

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Vestavia Hills, AL
  • NPI 1902859937
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302220800000",
    "number": "1033206065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ST VINCENTS DRIVE",
            "address_2": "#700",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35205",
            "telephone_number": "205-933-8981",
            "fax_number": "205-930-0746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ST VINCENTS DRIVE",
            "address_2": "#700",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35205",
            "telephone_number": "205-933-8981",
            "fax_number": "205-930-0746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLES",
        "middle_name": "H",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2011-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "AL",
            "license": "9666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528201860",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Mezzanares Clark, CRNA
• Brittney Clark, M.D.
• Callie Clark, NP
• Catherine Clark
• Charles Brendan Clark, PHD
• Christopher Michael Clark, M.D.
• Dennis Mark Clark, D.M.D., M.D
• Elizabeth Clark
• Grayson Powell Clark, MD
• Jacqueline Marie Clark, RN

• Neurological Surgery Physician in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Neurological Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2011; 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.