NPIMap

Individual provider Active NPI

Peter Earl Clark, MD

  • Urology Physician
  • Charlotte, NC
National Provider Identifier
1073595401
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
200200506 Issued in NC
Practice address
1021 Morehead Medical Dr
Ste 6100
Charlotte, NC 28204-2990
Phone
(980) 442-2000
NPI assigned
Nov 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 200200506 NC Primary

Addresses

Primary practice location

1021 Morehead Medical Dr
Ste 6100
Charlotte, NC 28204-2990

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

945 N 5th St
Albemarle, NC 28001-3417
Phone (980) 323-7790

Other practice location 2

1021 Morehead Medical Dr
Ste A
Charlotte, NC 28204-2990
Phone (980) 442-2000

Other practice location 3

1350 S Kings Dr
Charlotte, NC 28207-2134
Phone (704) 446-1255

Other practice location 4

100 Medical Park Dr
Ste 110
Concord, NC 28025-2948
Phone (704) 403-1370

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pclark137179@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170531000852 NC Practitioner - Urology 9133120058 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Harvard Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians
The Charlotte-Mecklenburg Hospital AuthorityGroup PAC ID 2961310685, 594 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

1021 Morehead Medical Dr
Suite 6100
Charlotte, NC 28204-2994
Phone (980) 442-2000

1021 Morehead Medical Dr
Suite a
Charlotte, NC 28204-2990
Phone (980) 442-2000

1225 Harding PL
Charlotte, NC 28204-2826

1237 Harding PL
Suite 3300
Charlotte, NC 28204-2826
Phone (704) 355-8816

2001 Vail Ave
Charlotte, NC 28207-1248
Phone (704) 304-5000

Hospital & facility affiliations

  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Atrium Health Pineville Hospital, Charlotte, NC, CCN 340098
  • Atrium Health Union Hospital, Monroe, NC, CCN 340130
  • Carolinas Medical Center-Northeast Hospital, Concord, NC, CCN 340001
  • Atrium Health Cleveland Hospital, Shelby, NC, CCN 340021

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Pathology Group, PA Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Aug 28, 2017 Accepting new patients
Carolinas Medical Center Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
Carolinas Medical Center CurrentSince Apr 1, 2017 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Urology CurrentSince Aug 28, 2017 Accepting new patients
Carolinas Medical Center Urology CurrentSince Apr 1, 2017 Accepting new patients
Wake Forest University Health Sciences Past Accepting new patients
Rancho Faculty Medical Associates, Inc. Past Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

945 N 5th St
Albemarle, NC 28001
Phone (980) 323-7790

1350 S Kings Dr
Charlotte, NC 28207
Phone (704) 446-1255

1021 Morehead Medical Dr
Ste A
Charlotte, NC 28204
Phone (704) 355-2884

1021 Morehead Medical Dr
Ste 6100
Charlotte, NC 28204
Phone (704) 355-1813

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

100 Medical Park Dr
Ste 110
Concord, NC 28025
Phone (704) 403-1370

441 McAlister Rd
Ste 1200
Lincolnton, NC 28092
Phone (980) 212-6200

Interoperability endpoints

  • Direct secure messaging: pclark137179@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1073595401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 MOREHEAD MEDICAL DR",
            "address_2": "STE 6100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042990",
            "telephone_number": "980-442-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "945 N 5th St",
            "address_purpose": "LOCATION",
            "city": "Albemarle",
            "state": "NC",
            "postal_code": "280013417",
            "country_code": "US",
            "telephone_number": "980-323-7790",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1021 Morehead Medical Dr",
            "address_2": "Ste A",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282042990",
            "country_code": "US",
            "telephone_number": "980-442-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1350 S Kings Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282072134",
            "country_code": "US",
            "telephone_number": "704-446-1255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Medical Park Dr",
            "address_2": "Ste 110",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252948",
            "country_code": "US",
            "telephone_number": "704-403-1370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PETER",
        "middle_name": "EARL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "200200506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pclark137179@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1021 Morehead Medical Dr",
            "address_2": "Ste 6100",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282042990",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.