NPIMap

Individual provider Active NPI

Carlos Stanford Clark II, MD

  • Family Medicine Physician
  • Dothan, AL
National Provider Identifier
1063851277
Registry record updated Aug 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD.32611 Issued in AL
Practice address
201 Doctors Drive
Dothan, AL 36301
Phone
(334) 794-6612
Fax
(334) 794-6614
NPI assigned
Jun 20, 2013
Last updated
Aug 18, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD.32611 AL Primary
Family Medicine Physician 207Q00000X ME116951 FL

Addresses

Primary practice location

201 Doctors Drive
Dothan, AL 36301

Mailing address

201 Doctors Drive
Dothan, AL 36301
Phone (334) 794-6612

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130827000105 AL Practitioner - Family Practice 3476796277 Reassigns benefits to 3 organizations
I20150406000624 FL Practitioner - Family Practice 3476796277 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Clinic PCGroup PAC ID 1355329269, 25 clinicians

Practice addresses (Care Compare)

201 Doctors Dr
Dothan, AL 36301-2949
Phone (334) 794-6611

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD.32611ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Clinic PC CurrentSince Aug 1, 2013 Accepting new patients
Southland Medical Solutions of Ozark, PL CurrentSince Jul 1, 2014 Accepting new patients
Houston County Healthcare Authority CurrentSince May 1, 2015 Accepting new patients
Houston County Healthcare Authority Family Medicine CurrentSince May 1, 2015 Accepting new patients
Houston County Healthcare Authority Family Medicine Current Accepting new patients
Crowne Health Care of Eufaula, LLC Past Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
United States Health & Housing Foundation, Inc Past Accepting new patients
The Health Care Authority of the City of Enterprise, Inc. Past Accepting new patients
Diversicare Hartford, LLC Past Accepting new patients
Ozark Health and Rehabilitation, LLC Past Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

201 Doctors Dr
Dothan, AL 36301
Phone (334) 794-6611

126 Hospital Ave
Ozark, AL 36360
Phone (334) 445-4803

1083 Sanders Ave
Graceville, FL 32440
Phone (334) 794-6611

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1720

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hartford Health CareHartford, AL, CCN 015419 Skilled nursing facility Contracted Managing Employee
Adp of the SNF		 Jul 1, 2020
Nov 25, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 11

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.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376784000000",
    "number": "1063851277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 DOCTORS DRIVE",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "36301",
            "telephone_number": "334-794-6612",
            "fax_number": "334-794-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 DOCTORS DRIVE",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "36301",
            "telephone_number": "334-794-6612",
            "fax_number": "334-794-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CARLOS",
        "middle_name": "STANFORD",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-20",
        "last_updated": "2013-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "MD.32611",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME116951",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.