Active NPI
Darrrius Clay
- Driver
- Middleton, WI
National Provider Identifier
1104539154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- C4001619522202
- Practice address
- 6808 University Ave Ste 108
Middleton, WI 53562-2779 - Phone
- (608) 225-4037
- NPI assigned
- Jan 4, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | C4001619522202 | WI | Primary |
Addresses
Primary practice location
6808 University Ave Ste 108
Middleton, WI 53562-2779
Mailing address
6808 University Ave Ste 108
Middleton, WI 53562-2779
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92-1469139 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C4001619522202 | WI | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672790400000",
"number": "1104539154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6808 UNIVERSITY AVE STE 108",
"city": "MIDDLETON",
"state": "WI",
"postal_code": "535622779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6808 UNIVERSITY AVE STE 108",
"city": "MIDDLETON",
"state": "WI",
"postal_code": "535622779",
"telephone_number": "608-225-4037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAY",
"first_name": "DARRRIUS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-04",
"last_updated": "2023-01-04",
"certification_date": "2023-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "WI",
"license": "C4001619522202",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "92-1469139",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.