Active NPI
Robert G. Clark, M.D.
- Family Medicine Physician
- San Pablo, CA
National Provider Identifier
1174511489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- C22168
- Practice address
- 2089 Vale Rd
Suite 17
San Pablo, CA 94806-3847 - Phone
- (510) 237-2802
- Fax
- (916) 239-3612
- NPI assigned
- Oct 11, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C22168 | CA | Primary |
Addresses
Primary practice location
2089 Vale Rd
Suite 17
San Pablo, CA 94806-3847
Mailing address
2160 Appian Way
Suite 200
Pinole, CA 94564-2524
Phone (510) 724-9110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C22168 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alliance Medical Group, Inc. | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217894400000",
"number": "1174511489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2160 APPIAN WAY",
"address_2": "SUITE 200",
"city": "PINOLE",
"state": "CA",
"postal_code": "945642524",
"telephone_number": "510-724-9110",
"fax_number": "916-239-3602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2089 VALE RD",
"address_2": "SUITE 17",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "948063847",
"telephone_number": "510-237-2802",
"fax_number": "916-239-3612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ROBERT",
"middle_name": "G.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-11",
"last_updated": "2008-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "C22168",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pablo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.