William Edward Clack, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

1181211 Issued in NY

Practice address

200 Madison Ave Ste 2B
Elmira, NY 14901-3219

Phone

(607) 732-1310

Fax

(607) 733-0940

NPI assigned

Nov 3, 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 NY

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

Specialty

Dermatology

Education

State University of New York at Buffalo School of Medicine, 1968

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arnot Ogden Medical CenterGroup PAC ID 5395798417, 219 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Arnot Ogden Medical Center Hospital, Elmira, NY, CCN 330090

Merit-based Incentive Payment System (MIPS)

Final score

80.15 of 100Reported as group

Quality

46.76

Promoting interoperability

100

Improvement activities

40

Cost

77.08

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: william.clack@arn.eclinicaldirectplus.com
• Direct secure messaging: wclack26594@direct.xtensys.com

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.

• Arnot Ogden Medical Center

  • General Acute Care Hospital
  • Elmira, NY
  • NPI 1083605661
  Medicare reassignment Care Compare group NPD
• Arnot Ogden Medical Center

  • Community/Retail Pharmacy
  • Elmira, NY
  • NPI 1831875004
  NPD

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

• Arnot Ogden Medical Center

  • General Acute Care Hospital
  • Elmira, NY
  • NPI 1083605661
  Care Compare affiliation

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1053490805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 SAINT JOSEPHS BLVD FL 2",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013230",
            "telephone_number": "607-271-2050",
            "fax_number": "607-873-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MADISON AVE STE 2B",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013219",
            "telephone_number": "607-732-1310",
            "fax_number": "607-733-0940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLACK",
        "first_name": "WILLIAM",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "1181211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00359366",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony N Ciccariello, DDS
• Mary P. Ciccariello, SP
• Laura Elizabeth Ciccotti, LMSW
• Alana Cicora
• Claudine O Ciprich, RN
• Everton George Clare, MD
• Betsey Ann Clark, DDS
• Emily Pauline Clark, PT,DPT
• Mandy Clark, NP
• Steven Richard Clark, DO

• Dermatology Physician in Elmira, NY
• Providers in Elmira, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; 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.

Verify at the official NPI Registry.