David Thomas Clark, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

150625 Issued in CA

Practice address

12401 Washington Blvd
Whittier, CA 90602-1006

Phone

(562) 698-0811

NPI assigned

Apr 4, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Emergency Medicine

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Coast Emergency Physicians 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Twin Cities Hospital, Templeton, CA, CCN 050633
• Adventist Health Sierra Vista Hospital, San Luis Obispo, CA, CCN 050506

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Central Coast Emergency Physicians

  • Emergency Medical Services (Emergency Medicine) Physician
  • Templeton, CA
  • NPI 1972535557

  CA, Emergency Medicine

  Medicare reassignment Care Compare group NPD
• Burbank Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Burbank, CA
  • NPI 1689636730

  CA, Emergency Medicine

  Medicare reassignment NPD
• Chino Emergency Medical Associates, Inc.

  • Emergency Medicine Physician
  • Chino, CA
  • NPI 1013282029

  CA, Emergency Medicine

  Medicare reassignment NPD
• Intercommunity Emergency Medical Group

  • Emergency Medicine Physician
  • Whittier, CA
  • NPI 1871535286

  CA, Emergency Medicine

  Medicare reassignment NPD

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

• Sierra Vista Hospital, Inc.

  • General Acute Care Hospital
  • San Luis Obispo, CA
  • NPI 1639101116

  Hospital

  Care Compare affiliation
• Twin Cities Community Hospital, Inc.

  • General Acute Care Hospital
  • Templeton, CA
  • NPI 1396778197

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597017600000",
    "number": "1104289495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12041 WASHINGTON BLVD",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906062609",
            "telephone_number": "562-698-0811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12401 WASHINGTON BLVD",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906021006",
            "telephone_number": "562-698-0811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 S Buena Vista St",
            "address_purpose": "LOCATION",
            "city": "Burbank",
            "state": "CA",
            "postal_code": "915054809",
            "country_code": "US",
            "telephone_number": "818-843-5111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 N State St",
            "address_2": "Clinic Tower, Suite A7D",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900331029",
            "country_code": "US",
            "telephone_number": "315-272-6903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAVID",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-04",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "150625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristy Narom Chung, N.P.
• Rachel Yejin Chyun
• Viviana Cintron
• Charlene Ciruelas, PHARMD
• Catherine Cizmar, OD
• Kaitlyn Nicole Clark, PA-C
• Stuart McPherson Clements, D.D.S.
• Melvin W. Coats, M.D.
• Daniel Cobau, D.O.
• Henry N Cobau, M.D.

• All providers in Whittier, CA
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.