Edward C Clark, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

D0017492 Issued in MD

Practice address

11355 Pembrooke SQ
Suite 107
Waldorf, MD 20603-4805

Phone

(301) 843-7711

Fax

(301) 932-9195

NPI assigned

Jul 28, 2005

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

23.69 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

78.96

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470614400000",
    "number": "1124028311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11355 PEMBROOKE SQ",
            "address_2": "SUITE 107",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034805",
            "telephone_number": "301-843-7711",
            "fax_number": "301-932-9195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11355 PEMBROOKE SQ",
            "address_2": "SUITE 107",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034805",
            "telephone_number": "301-843-7711",
            "fax_number": "301-932-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "EDWARD",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2016-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MD",
            "license": "D0017492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "228502900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Circles Behavioral Health, Inc.
• Citadel Management Group Inc.
• Civista Clinical Services LLC
• Civista Partners Ambulatory Surgery Center
• Darrell Adrian Clark, D.D.S.
• Nakia Shanthanee Clark, LCSW-C
• Pia N Clark, RPH
• Sydnee Clark
• Nicola Clarke Wallen, PMHNP
• CLCD Enterprise Inc

• Ophthalmology Physician in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Ophthalmology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.