Christopher C Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-06158 Issued in NC

Practice address

2076 Hwy 42 W
Clayton, NC 27520-5302

Phone

(919) 763-1050

NPI assigned

Jan 14, 2016

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 NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Emergeortho PA

  • Orthopaedic Surgery Physician
  • Durham, NC
  • NPI 1376592964

  Physician Assistant

  Medicare reassignment NPD
• Emergeortho PA

  • Durable Medical Equipment & Medical Supplies
  • Eden, NC
  • NPI 1841170222
  NPD

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

{
    "created_epoch": "1452729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1104282540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5105",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049155100",
            "telephone_number": "919-220-5255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2076 HWY 42 W",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275205302",
            "telephone_number": "919-763-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHRISTOPHER",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-14",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "0010-06158",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Child & Family Counseling Services PLLC
• Stellah Rudo Chinamora
• Mary Chong
• Chosen Ones Home Health Care
• Christy Stith Chrisp
• Mary Kristen Clark, SLP
• Saige Clark
• Clayton Area Rescue, Inc
• Clayton Audiology PLLC
• Clayton Chiropractic Center, P.a.

• Physician Assistant in Clayton, NC
• Providers in Clayton, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; 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.