Christopher Shadburn Clark, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME80173 Issued in FL

Practice address

777 37TH St
Vero Beach, FL 32960-4873

Phone

(772) 778-7217

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Infinity Health

  • Federally Qualified Health Center (FQHC)
  • Bedford, IA
  • NPI 1417768565
  NPD (past)
• Nurse in the House, Inc.

  • Home Health Agency
  • Des Moines, IA
  • NPI 1598196040
  NPD (past)
• Optimae Lifeservices, Inc,

  • Community/Behavioral Health Agency
  • Fairfield, IA
  • NPI 1174520084
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184721912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 TULIP LN",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329632101",
            "telephone_number": "772-234-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 37TH ST",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604873",
            "telephone_number": "772-778-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHRISTOPHER",
        "middle_name": "SHADBURN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME80173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261068000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bettie Cius
• Claras Place Inc
• Clarice Ellen Donahue LLC
• Clark Chiropractic Center Inc
• Ashlee Antoinette Clark, RN
• Michael James Clark, D.C.
• Fredericka Clarke, AU.D.
• Paula D Clarke
• Carl Jeffrey Clay, D.D.S.
• Morgan Elizabeth Clay, DMD

• Psychiatry Physician in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.