Garrett Clark, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

OS014422 Issued in PA

Practice address

5401 Peach St
Suite 3500
Erie, PA 16509-2601

Phone

(814) 868-2179

Fax

(814) 868-2346

NPI assigned

Jul 24, 2008

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 PA

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 Osteopathy

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552003200000",
    "number": "1063677524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LECOM PL",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165052571",
            "fax_number": "814-868-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 PEACH ST",
            "address_2": "SUITE 3500",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092601",
            "telephone_number": "814-868-2179",
            "fax_number": "814-868-2346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GARRETT",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-24",
        "last_updated": "2019-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS014422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022612880004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher C Clark, DO
• Danielle Y Clark, NCP
• Edward C Clark, M.D.
• Elaina Marie Clark, CRNP
• Eric Clark
• Geralynn Mary Clark
• Mindy M Clark, CNM
• Rebecca Clark, LCSW
• Zachary Clark
• Maurice Orlando Clarke, LPC

• Internal Medicine Physician in Erie, PA
• Providers in Erie, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; 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.