Active NPI
John Elliott Clark, M.D.
- Surgery Physician
- Washington, DC
National Provider Identifier
1174610570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD14155
- Practice address
- 50 Irving St NW
Ste 412
Washington, DC 20422-0001 - Phone
- (202) 507-9952
- Fax
- (202) 836-6921
- NPI assigned
- Oct 6, 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD14155 | DC | Primary |
Addresses
Primary practice location
50 Irving St NW
Ste 412
Washington, DC 20422-0001
Mailing address
50 Irving St NW
Ste 412
Washington, DC 20422-0001
Phone (202) 507-9952
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7666 | Other | DC | CAREFIRST |
| 00247377 | Medicaid | DC |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486684800000",
"number": "1174610570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 IRVING ST NW",
"address_2": "STE 412",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "204220001",
"telephone_number": "202-507-9952",
"fax_number": "202-836-6921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 IRVING ST NW",
"address_2": "STE 412",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "204220001",
"telephone_number": "202-507-9952",
"fax_number": "202-836-6921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JOHN",
"middle_name": "ELLIOTT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2017-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "DC",
"license": "MD14155",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST",
"identifier": "7666",
"state": "DC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00247377",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.