NPIMap

Individual provider Active NPI

James G Clark, MD

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
National Provider Identifier
1093712556
Registry record updated May 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD2006-0077 Issued in NM
Practice address
315 Isle of Capri Dr
Fort Lauderdale, FL 33301-2409
Phone
(954) 319-0225
NPI assigned
Jun 30, 2005
Last updated
May 15, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD2006-0077 NM Primary

Addresses

Primary practice location

315 Isle of Capri Dr
Fort Lauderdale, FL 33301-2409

Mailing address

315 Isle of Capri Dr
Fort Lauderdale, FL 33301-2409
Phone (954) 319-0225

Other identifiers 1

IdentifierTypeStateIssuer
12232033MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, NV2 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
I20130627000650 AL Practitioner - Emergency Medicine 2466344882 Reassigns benefits to 1 organization
I20210727001275 NV Practitioner - Emergency Medicine 2466344882 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Saint Louis University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lola Emergency Physicians LLCGroup PAC ID 9234464124, 9 clinicians

Practice addresses (Care Compare)

360 S Lola LN
Pahrump, NV 89048-0884
Phone (954) 939-5000

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as virtual group
Quality
0
Improvement activities
0
Cost
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD2006-0077NMMDEmergency Medicine Physician
21274FLMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
South Lyon Health Center, Inc. CurrentSince Aug 1, 2022 Accepting new patients
South Lyon Health Center, Inc. Current Accepting new patients
South Lyon Health Center, Inc. CurrentSince Aug 1, 2022 Accepting new patients
Lola Emergency Physicians LLC Emergency Medicine CurrentSince Jun 16, 2021 Accepting new patients
South Lyon Health Center, Inc. Current Accepting new patients
Oleta River Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Gulfstream Emergency Physicians Emergency Medicine Past Accepting new patients
Emergency Physician Solutions of South Florida, LLC Emergency Medicine PastSince Mar 1, 2020 Accepting new patients
Aventura Emergency Associates, LLC Emergency Medicine Past Accepting new patients
Floridian Emergency Specialists, LLC Emergency Medicine PastSince Jan 26, 2020 Accepting new patients

Locations

360 S Lola Ln
Pahrump, NV 89048
Phone (775) 751-7500

213 S Whitacre St
Yerington, NV 89447
Phone (775) 463-2301

Organizations & group practices 12

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": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431648000000",
    "number": "1093712556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 ISLE OF CAPRI DR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333012409",
            "telephone_number": "954-319-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 ISLE OF CAPRI DR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333012409",
            "telephone_number": "954-319-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JAMES",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2015-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "MD2006-0077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12232033",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.