Active NPI
Timothy M Clark, MD
- Pulmonary Disease Physician
- Boulder, CO
National Provider Identifier
1043265663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 38716
- Practice address
- 4820 Riverbend Rd Ste 100
Boulder, CO 80301-2618 - Phone
- (303) 415-5399
- Fax
- (303) 297-5808
- NPI assigned
- May 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 38716 | CO | |
| Pulmonary Disease Physician | 207RP1001X | 38716 | CO | Primary |
Addresses
Primary practice location
4820 Riverbend Rd Ste 100
Boulder, CO 80301-2618
Mailing address
5450 Western Ave
Boulder, CO 80301-2709
Phone (303) 415-5399
Other practice location 1
90 Health Park Dr Ste 130
Louisville, CO 80027-9586
Phone (303) 415-5399
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
| License | State | Type | Specialty |
|---|---|---|---|
| 38716 | CO | MD | Critical Care Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boulder Community Health | Past | Accepting new patients |
Interoperability endpoints
- tclark@bch.gwaydirect.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 and National Provider Directory roles.
-
- Medical Specialty Clinic/Center
- Boulder, CO
- NPI 1407685498
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557446400000",
"number": "1043265663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5450 WESTERN AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803012709",
"telephone_number": "303-415-5399",
"fax_number": "303-297-5808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4820 RIVERBEND RD STE 100",
"city": "BOULDER",
"state": "CO",
"postal_code": "803012618",
"telephone_number": "303-415-5399",
"fax_number": "303-297-5808"
}
],
"practiceLocations": [
{
"address_1": "90 Health Park Dr Ste 130",
"address_purpose": "LOCATION",
"city": "Louisville",
"state": "CO",
"postal_code": "800279586",
"country_code": "US",
"telephone_number": "303-415-5399",
"fax_number": "303-297-5808",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLARK",
"first_name": "TIMOTHY",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-23",
"last_updated": "2019-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "CO",
"license": "38716",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "CO",
"license": "38716",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.