Kerry R Clark, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G60150 Issued in CA

Practice address

25751 McBean Pkwy
Ste 210
Valencia, CA 91355-3701

Phone

(661) 284-3100

Fax

(661) 290-3310

NPI assigned

Oct 6, 2006

Last updated

Jun 24, 2009By 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 1

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

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: kerry.clark.p1@direct.nevhc.nextgenshare.com

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.

• Northeast Valley Health Corporation

  dba Van Nuys Adult Health Center

  • Federally Qualified Health Center (FQHC)
  • Van Nuys, CA
  • NPI 1629079009
  Medicare reassignment NPD
• Northeast Valley Health Corporation

  • Federally Qualified Health Center (FQHC)
  • Sun Valley, CA
  • NPI 1013199264
  NPD
• Motion Picture and Television Fund Medical Group Inc

  • Internal Medicine Physician
  • Woodland Hills, CA
  • NPI 1013942622
  NPD (past)
• Motion Picture and Television Fund Medical Group Inc

  • Geriatric Medicine (Internal Medicine) Physician
  • Woodland Hills, CA
  • NPI 1528265584
  NPD (past)
• Motion Picture and Television Fund Medical Group, Inc

  • Internal Medicine Physician
  • Glendale, CA
  • NPI 1821324542
  NPD (past)
• Regents of the University of California

  dba UCLA Entertainment Ind Medgrp

  • Durable Medical Equipment & Medical Supplies
  • Woodland Hills, CA
  • NPI 1083063127
  NPD (past)

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245801600000",
    "number": "1093802365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23388 MULHOLLAND DR",
            "address_2": "MAILSTOP 62",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913642733",
            "telephone_number": "818-876-1636",
            "fax_number": "661-290-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25751 MCBEAN PKWY",
            "address_2": "STE 210",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913553701",
            "telephone_number": "661-284-3100",
            "fax_number": "661-290-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KERRY",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2009-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G60150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G771370",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tye Shia Claibourn
• Clara Hwang Moon
• Clare Macaulay DDS, Inc.
• Clarity Mental Wellness Inc
• Benjamin Clark, AMFT
• Clear Hearing Inc
• Janica Pauline Clemente, PTA
• Laila Clemons
• Taylor Marie Clemons, AMFT
• Jan Marie Click, MSW

• Internal Medicine Physician in Valencia, CA
• Providers in Valencia, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; 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.