Active NPI
Stephen Sidney Clark, M.D.
- Surgery Physician
- Austin, TX
National Provider Identifier
1164401089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- D4955
- Practice address
- 3705 Medical Pkwy
Suite 250
Austin, TX 78705-1019 - Phone
- (512) 302-1210
- NPI assigned
- Jan 10, 2006
- Last updated
- Feb 16, 2012
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | D4955 | TX | Primary |
Addresses
Primary practice location
3705 Medical Pkwy
Suite 250
Austin, TX 78705-1019
Mailing address
3705 Medical Pkwy
Suite 250
Austin, TX 78705-1019
Phone (512) 334-1885
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D4955 | TX | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329350400000",
"number": "1164401089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3705 MEDICAL PKWY",
"address_2": "SUITE 250",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787051019",
"telephone_number": "512-334-1885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3705 MEDICAL PKWY",
"address_2": "SUITE 250",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787051019",
"telephone_number": "512-302-1210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "STEPHEN",
"middle_name": "SIDNEY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2012-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "TX",
"license": "D4955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.