Peter J Clark, D.O.
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Bedminster, NJ
NPI 1164664967 · NPPES record last updated Jul 8, 2022
Key facts
- NPI
- 1164664967
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- 25MB09216800 (NJ)
- Practice address
- 1 Robertson Dr
Bedminster, NJ 07921-1716 - Phone
- (908) 277-8900
- Fax
- (908) 476-5666
- NPI assigned
- Mar 25, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 24
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Lake Erie College of Osteopathic Medicine, Erie, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Summit Medical Group PA
Practice addresses (Care Compare)
1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160212000753 | NJ | Practitioner - Psychiatry | 4082918917 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MB09216800 | NJ | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Group PA | Current |
Accepting new patients | |
| Summit Medical Group PA | Current |
Accepting new patients |
Locations
1 Diamond Hill Rd
Berkeley Heights, NJ 07922
Phone (908) 277-8868
100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210
150 Floral Ave
New Providence, NJ 07974
Phone (908) 588-3890
Interoperability endpoints
- peter.clark.1@2983.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 25MB09216800 | NJ | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 25MB09216800 | NJ | Yes |
Addresses
Primary practice location
1 Robertson Dr
Bedminster, NJ 07921-1716
Mailing address
1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300
Other providers in Bedminster, NJ
- Corinne L Celentano
- Katheryn A Celentano
- Peter S. Chan
- Chiropractic Care of Bedminster, P.C.
- Ariel Cifuentes
- Jason Cross
- Dominique D'Angelo
- Danielle Malysa LCSW
- Kent Earle Davis
- Delta Community Supports, Inc.
All providers in Bedminster, NJ · Child & Adolescent Psychiatry Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.