Gary L Clark, PA C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA2265 Issued in FL

Practice address

605 Lamar Ave
Brooksville, FL 34601-3211

Phone

(352) 799-5411

Fax

(352) 544-2713

NPI assigned

Sep 1, 2005

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 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Rural Medical Associates Inc

  • Rural Health Clinic/Center
  • Wildwood, FL
  • NPI 1770570806
  NPD (past)

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1114911328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 LAMAR AVE",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346013211",
            "telephone_number": "352-799-5411",
            "fax_number": "352-544-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 LAMAR AVE",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346013211",
            "telephone_number": "352-799-5411",
            "fax_number": "352-544-2713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GARY",
        "middle_name": "L",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA2265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "900013195",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970029323",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS FL",
            "identifier": "Y00ZL",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290338500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970028329",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Christiansen, DO
• Lucille Chwalik
• Cimarrone Transportation
• Barbara Ann Clair Harris, RDH
• Alexa Clark, PHARMD
• Robert Clark, LPN
• Clear Sky Music and Sound Therapeutics, LLC
• Clear Vision Optical Inc
• Michele Clouthier, APRN, FNP-BC
• Coast Florida P.a.

• Medical Physician Assistant in Brooksville, FL
• Providers in Brooksville, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.