Active NPI
John Clarke
- Anesthesiology Physician
- Clearlake, CA
National Provider Identifier
1053329359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- NA1636
- Practice address
- 15630 18TH Ave
Clearlake, CA 95422 - Phone
- (707) 994-6486
- NPI assigned
- Aug 3, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | NA1636 | CA | Primary |
Addresses
Primary practice location
15630 18TH Ave
Clearlake, CA 95422
Mailing address
1750 Westlake Dr
Kelseyville, CA 95451-7049
Phone (707) 994-6486
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
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NA1636 | CA | MD | Anesthesiology Physician |
| 1636 | CA | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Specialty Care and Surgery Center | Past | Accepting new patients |
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.
-
- Gynecology Physician
- Kelseyville, CA
- NPI 1073648630
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053329359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 WESTLAKE DR",
"city": "KELSEYVILLE",
"state": "CA",
"postal_code": "954517049",
"telephone_number": "707-994-6486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15630 18TH AVE",
"city": "CLEARLAKE",
"state": "CA",
"postal_code": "95422",
"telephone_number": "707-994-6486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "JOHN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "NA1636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearlake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.