NPIMap

Individual provider Active NPI

Clark B Diffendaffer, MD

  • Diagnostic Radiology Physician
  • Lincoln, NE
National Provider Identifier
1174612337
Registry record updated Jan 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
TRN9101 Issued in FL
Practice address
7601 Pioneers Blvd
Lincoln, NE 68506-4675
Phone
(402) 484-6677
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 24399 NE
Diagnostic Radiology Physician 2085R0202X TRN9101 FL Primary

Addresses

Primary practice location

7601 Pioneers Blvd
Lincoln, NE 68506-4675

Mailing address

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 200-2355

Other practice location 1

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 200-2355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190618002931 FL Practitioner - Diagnostic Radiology 4082746714 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Nebraska College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Medical Imaging LLC 38 clinicians
Radiology Associates PC 33 clinicians

Practice addresses (Care Compare)

9724 Lake Hugh Dr
Gotha, FL 34734-4629
Phone (800) 475-6236

Hospital & facility affiliations

  • York General Health Care Services Hospital, York, NE, CCN 281336
  • Phelps Memorial Health Center Hospital, Holdrege, NE, CCN 281362
  • Jefferson Community Health & Life Hospital, Fairbury, NE, CCN 281319
  • Pender Community Hospital Hospital, Pender, NE, CCN 281349
  • Fillmore County Hospital Hospital, Geneva, NE, CCN 281301

Merit-based Incentive Payment System (MIPS)

Final score
80.5 of 100Reported as group
Quality
100
Improvement activities
40
Cost
35

Merit-based Incentive Payment System (MIPS)

Final score
89.57 of 100Reported as group
Quality
100
Improvement activities
40
Cost
65.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TRN9101FLMDDiagnostic Radiology Physician
24399NEMDDiagnostic Radiology Physician

Practice roles (4 of 5)

OrganizationSpecialtyStatusNew patients
Radiology Associates PC Diagnostic Radiology CurrentSince Dec 1, 2021 Accepting new patients
Advanced Medical Imaging, LLC Diagnostic Radiology CurrentSince Feb 1, 2026 Accepting new patients
Florida Radiology Imaging at Lake Mary, LLC Diagnostic Radiology CurrentSince Jul 22, 2019 Accepting new patients
Madonna Rehabilitation Hospital CurrentSince Oct 23, 2025 Accepting new patients

Locations

900 Winderley Pl
Ste 2100
Maitland, FL 32751
Phone (407) 200-1606

235 E Princeton St
Ste 100
Orlando, FL 32804
Phone (407) 303-1414

7601 Pioneers Blvd
Lincoln, NE 68506
Phone (402) 484-4475

7555 Pioneers Blvd
Lincoln, NE 68506
Phone (402) 261-1085

Networks

  • Freedom Health HMO Network

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1174612337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E ROLLINS ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031248",
            "telephone_number": "407-200-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 PIONEERS BLVD",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685064675",
            "telephone_number": "402-484-6677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 E Rollins St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328031248",
            "country_code": "US",
            "telephone_number": "407-200-2355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIFFENDAFFER",
        "first_name": "CLARK",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NE",
            "license": "24399",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "TRN9101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.