NPIMap

Individual provider Active NPI

Robert Joel Clark, PA-C

  • Physician Assistant
  • Greenville, NC
National Provider Identifier
1063411023
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
584 Issued in WV
Practice address
2000 Venture Tower Dr
Greenville, NC 27834
Phone
(866) 439-3132
NPI assigned
Jul 20, 2005
Last updated
Jun 3, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-06044 NC
Physician Assistant 363A00000X 584 WV Primary

Addresses

Primary practice location

2000 Venture Tower Dr
Greenville, NC 27834

Mailing address

1325 Horner St
Elizabeth City, NC 27909-6113
Phone (304) 266-7064

Other practice location 1

Route 4 & 20 S. Intersection
Rock Cave, WV 26234
Phone (304) 924-6262

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
584WVMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care of West Virginia, Inc. Past Accepting new patients
Community Care of West Virginia, Inc. Past Accepting new patients
Wheeler Peak Emergency Physicians LLC Physician Assistant Past Accepting new patients
Whipple Tree Emergency Physicians LLC Physician Assistant Past Accepting new patients
Bestpractices of West Virginia, Inc. Past Accepting new patients
North Carolina Em I Medical Services P C Physician Assistant Past Accepting new patients
Waterway Emergency Physicians LLC Past Accepting new patients
Marshall West Virginia Ed Associates, LLC Past Accepting new patients

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1063411023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 HORNER ST",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279096113",
            "telephone_number": "304-266-7064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 VENTURE TOWER DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "27834",
            "telephone_number": "866-439-3132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Route 4 & 20 S. Intersection",
            "address_purpose": "LOCATION",
            "city": "Rock Cave",
            "state": "WV",
            "postal_code": "26234",
            "country_code": "US",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROBERT",
        "middle_name": "JOEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06044",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.

Verify at the official NPI Registry.