NPIMap

Individual provider Active NPI

Iris Kalin Clark, M.D.

  • Family Medicine Physician
  • Statesboro, GA
National Provider Identifier
1174887004
Registry record updated May 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
73272 Issued in GA
Practice address
1550 Brampton Ave
Ste B
Statesboro, GA 30458-0886
Phone
(912) 623-2155
Fax
(912) 623-5156
NPI assigned
Jun 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 73272 GA Primary

Addresses

Primary practice location

1550 Brampton Ave
Ste B
Statesboro, GA 30458-0886

Mailing address

1550 Brampton Ave
Ste B
Statesboro, GA 30458-0886
Phone (912) 623-2155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20151103003225 GA Practitioner - Family Practice 6305085259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clark Medical Group LLC 2 clinicians

Practice addresses (Care Compare)

117 Hill Pond LN
Statesboro, GA 30458-0872
Phone (912) 623-2155

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Statesboro, GA, CCN 117033
  • Regency Southerncare Hospice, Augusta, GA, CCN 111637
  • Gentiva Hospice, Savannah, GA, CCN 111615
  • Gentiva Hospice, Bainbridge, GA, CCN 111556
  • Ogeechee Area Hospice, Inc. Hospice, Statesboro, GA, CCN 111535
  • East Georgia Regional Medical Center Hospital, Statesboro, GA, CCN 110075
  • Jeff Davis Hospital Hospital, Hazlehurst, GA, CCN 111333
  • Candler County Hospital Hospital, Metter, GA, CCN 111334
  • Brown's Health and Rehabilitation Nursing home, Statesboro, GA, CCN 115604

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73272GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clark Medical Group, LLC Family Medicine CurrentSince Jan 1, 2016 Accepting new patients
BN SNF LLC Past Accepting new patients
Statesboro Opco LLC Past Accepting new patients

Locations

1550 Brampton Ave
Ste B
Statesboro, GA 30458
Phone (912) 623-2155

117 Hill Pond Ln
Statesboro, GA 30458
Phone (912) 623-2155

Interoperability endpoints

  • Direct secure messaging: clarkmedicalgroup.irisclark@132499.advancedmd-direct.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brown'S Health and RehabilitationStatesboro, GA, CCN 115604 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2025
May 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 9

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": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1174887004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 BRAMPTON AVE",
            "address_2": "STE B",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580886",
            "telephone_number": "912-623-2155",
            "fax_number": "912-623-2156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 BRAMPTON AVE",
            "address_2": "STE B",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580886",
            "telephone_number": "912-623-2155",
            "fax_number": "912-623-5156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "IRIS",
        "middle_name": "KALIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-26",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "73272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

Verify at the official NPI Registry.