Clark Larkin Gifford, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G47524 Issued in CA

Practice address

7117 Brockton Ave
Riverside, CA 92506-2615

Phone

(951) 782-3685

Fax

(951) 784-3256

NPI assigned

Nov 10, 2005

Last updated

Dec 2, 2011By the provider in NPPES

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 2

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Riverside Medical Clinic, Inc

  dba Riverside Medical Clinic

  • Dermatology Physician
  • Riverside, CA
  • NPI 1720183403
  Medicare reassignment NPD
• Riverside Medical Clinic, Inc

  dba Riverside Medical Clinic

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1730180415

  Pediatrics

  NPD

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322784000000",
    "number": "1063493435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 ARLINGTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063912",
            "telephone_number": "951-782-3685",
            "fax_number": "951-784-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7117 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062615",
            "telephone_number": "951-782-3685",
            "fax_number": "951-784-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIFFORD",
        "first_name": "CLARK",
        "middle_name": "LARKIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2011-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G47524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI NUMBER",
            "identifier": "1730180415",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP SITE NUMBER",
            "identifier": "ZZZ31887Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James A Gibson, OD
• Karla Gibson
• Melissa Ann Gibson, LMFT
• Sabina Maria Ortega Gidaya
• Betina Gideon-Greer, M.D.
• Rachel Anne Gifford
• Robert Clark Gifford, DPM
• Gifted Hands LLC
• Nayeli Sarahi Gil Tamayo, MSW
• Evelyn Gil

• Pediatrics Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.