Active NPI
Craig Anthony Clark, M.D.
- Psychiatry Physician
- Nashville, TN
National Provider Identifier
1164529186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD0000019947
- Practice address
- 30 Burton Hills Blvd
Suite 375
Nashville, TN 37215-6140 - Phone
- (615) 327-4877
- Fax
- (615) 327-4881
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD0000019947 | TN | Primary |
Addresses
Primary practice location
30 Burton Hills Blvd
Suite 375
Nashville, TN 37215-6140
Mailing address
30 Burton Hills Blvd
Suite 375
Nashville, TN 37215-6140
Phone (615) 327-4877
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 163480 | Other | TN | BCBS |
| 3074363 | Medicaid | TN |
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2013 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000019947 | TN | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164529186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 BURTON HILLS BLVD",
"address_2": "SUITE 375",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372156140",
"telephone_number": "615-327-4877",
"fax_number": "615-327-4881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 BURTON HILLS BLVD",
"address_2": "SUITE 375",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372156140",
"telephone_number": "615-327-4877",
"fax_number": "615-327-4881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CRAIG",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TN",
"license": "MD0000019947",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "163480",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3074363",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nashville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.