Active NPI
Dwight Eugene Clark, O.D.
- Optometrist
- Rancho Cordova, CA
National Provider Identifier
1043321169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 5512
- Practice address
- 11216 Trinity River Drive
Rancho Cordova, CA 95670 - Phone
- (916) 635-6161
- Fax
- (916) 631-3788
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5512 | CA | Primary |
Addresses
Primary practice location
11216 Trinity River Drive
Rancho Cordova, CA 95670
Mailing address
11216 Trinity River Drive
Rancho Cordova, CA 95670
Phone (916) 635-6161
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0055120 | Medicaid | CA |
Medicare participation
Medicare enrollment files- 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: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern California College of Optometry, 1972
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
650 Howe Ave
Suite 830
Sacramento, CA 95825-4797
Phone (916) 564-9990
Merit-based Incentive Payment System (MIPS)
- Final score
- 99.04 of 100
- Quality
- 100
- Improvement activities
- 40
- Cost
- 80.15
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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.
-
- Ophthalmology Physician
- Rancho Cordova, CA
- NPI 1841326824
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322438400000",
"number": "1043321169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11216 TRINITY RIVER DRIVE",
"city": "RANCHO CORDOVA",
"state": "CA",
"postal_code": "95670",
"telephone_number": "916-635-6161",
"fax_number": "916-631-3788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11216 TRINITY RIVER DRIVE",
"city": "RANCHO CORDOVA",
"state": "CA",
"postal_code": "95670",
"telephone_number": "916-635-6161",
"fax_number": "916-631-3788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DWIGHT",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2011-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "5512",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0055120",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cordova, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.
- 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.