NPIMap

Individual provider Active NPI

Brian Thomas Clark, M.D.

  • Gastroenterology Physician
  • Stoneham, MA
National Provider Identifier
1114193612
Registry record updated Jan 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
262160 Issued in MA
Practice address
51 Montvale Ave
Stoneham, MA 02180-2417
Phone
(781) 213-5200
Fax
(781) 481-9016
NPI assigned
May 5, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 49635 CT
Gastroenterology Physician 207RG0100X 262160 MA Primary

Addresses

Primary practice location

51 Montvale Ave
Stoneham, MA 02180-2417

Mailing address

51 Montvale Ave
Stoneham, MA 02180-2417
Phone (781) 213-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150708001089 MA Practitioner - Gastroenterology 2264619667 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Boston University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beth Israel Lahey Health Specialty Care, Inc.Group PAC ID 2365405024, 264 clinicians

Practice addresses (Care Compare)

41 Mall Rd
Burlington, MA 01805-0001
Phone (781) 744-8400

Hospital & facility affiliations

  • Winchester Hospital Hospital, Winchester, MA, CCN 220105
  • Tufts Medical Center Hospital, Boston, MA, CCN 220116
  • Beth Israel Deaconess Medical Center Hospital, Boston, MA, CCN 220086
  • Northeast Hospital Corporation Hospital, Beverly, MA, CCN 220033

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy221
Upper gastrointestinal (GI) endoscopy for acid reflux148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49635CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Winchester Physician Associates, Inc Internal Medicine CurrentSince Feb 15, 2024 Accepting new patients
Hallmark Health Medical Associates Inc Internal Medicine CurrentSince Apr 17, 2015 Accepting new patients
Beth Israel Lahey Health Specialty Care, Inc. CurrentSince Dec 1, 2024 Accepting new patients
Beth Israel Lahey Health Specialty Care, Inc. Internal Medicine CurrentSince Dec 1, 2024 Accepting new patients
Winchester Physician Associates Internal Medicine Past Accepting new patients
Tufts Medical Center, Inc. Past Accepting new patients

Locations

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

203 Main St
North Reading, MA 01864
Phone (978) 664-1990

425 Revere St
Revere, MA 02151
Phone (781) 286-1313

51 Montvale Ave
Stoneham, MA 02180
Phone (781) 213-5200

41 Highland Ave
Winchester, MA 01890
Phone (781) 756-2000

800 W Cummings Park
Ste 5950
Woburn, MA 01801
Phone (617) 816-2087

Interoperability endpoints

  • Direct secure messaging: bclark90883@direct.bilh.masshiway.net

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451952000000",
    "number": "1114193612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 MONTVALE AVE",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021802417",
            "telephone_number": "781-213-5200",
            "fax_number": "781-481-9016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 MONTVALE AVE",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021802417",
            "telephone_number": "781-213-5200",
            "fax_number": "781-481-9016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRIAN",
        "middle_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-05",
        "last_updated": "2016-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "49635",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MA",
            "license": "262160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoneham, MA

Sources for this page

Verify at the official NPI Registry.