NPIMap

Individual provider Active NPI

Jonathan Clark, M.D.

  • Family Medicine Physician
  • Danville, KY
National Provider Identifier
1154415156
Registry record updated Aug 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
KY35658 Issued in KY
Practice address
109 Daniel Dr
Danville, KY 40422-2527
Phone
(859) 236-3361
Fax
(859) 239-9484
NPI assigned
Oct 3, 2006
Last updated
Aug 30, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X KY35658 KY Primary

Addresses

Primary practice location

109 Daniel Dr
Danville, KY 40422-2527

Mailing address

PO Box 990
Danville, KY 40423-0990
Phone (859) 236-3361

Other identifiers 1

IdentifierTypeStateIssuer
64015225MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20091222000209 KY Practitioner - Family Practice 4486794583 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kentucky College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

110 Metker TRL
Stanford, KY 40484-1020
Phone (606) 365-3360

217 S 3Rd St
Danville, KY 40422-1823
Phone (859) 239-2318

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.36 of 100Reported as group
Quality
64.78
Promoting interoperability
100
Improvement activities
40
Cost
67.25

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
KY35658KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ephraim McDowell Health Resource, Inc Family Medicine CurrentSince Jun 1, 2003 Accepting new patients
Ephraim McDowell Regional Medical Center Incorporated CurrentSince Jul 21, 2019 Accepting new patients
Ephraim McDowell Health Resource, Inc. Family Medicine CurrentSince Jun 1, 2003 Accepting new patients
Ephraim McDowell Health Resource, Inc. Family Medicine Current Accepting new patients
The James B. Haggin Memorial Hospital Inc CurrentSince Jan 1, 2019 Accepting new patients
The James B. Haggin Memorial Hospital Inc Current Accepting new patients
Ephraim McDowell Regional Medical Center, Incorporated CurrentSince Jul 21, 2019 Accepting new patients
The James B. Haggin Memorial Hospital Inc. CurrentSince Jan 1, 2019 Accepting new patients
Ephraim McDowell Regional Medical Center Incorporated Family Medicine Past Accepting new patients

Locations

109 Daniel Dr
Danville, KY 40422
Phone (859) 236-3361

1541 Lebanon Rd
Ste 1
Danville, KY 40422
Phone (859) 236-3208

216 W Walnut St
Ste A
Danville, KY 40422
Phone (859) 239-5870

217 S 3rd St
Danville, KY 40422
Phone (859) 239-1000

1509 Louisville Rd
Harrodsburg, KY 40330
Phone (859) 236-7712

464 Linden Ave
Harrodsburg, KY 40330
Phone (859) 734-5441

510 N Camp Dick Rd
Lancaster, KY 40444
Phone (859) 548-8000

511 Middleburg St
Liberty, KY 42539
Phone (606) 236-2388

110 Metker Trl
Stanford, KY 40484
Phone (606) 365-3360

5130 Parkway Plaza Blvd
Charlotte, NC 28217

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314662400000",
    "number": "1154415156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 990",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404230990",
            "telephone_number": "859-236-3361",
            "fax_number": "859-239-9484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 DANIEL DR",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404222527",
            "telephone_number": "859-236-3361",
            "fax_number": "859-239-9484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JONATHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2011-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "KY35658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64015225",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, KY

Sources for this page

Verify at the official NPI Registry.