Active NPI
Patrick Elvin Clarke, M.D.
- Internal Medicine Physician
- Tustin, CA
National Provider Identifier
1194015891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- A114369
- Practice address
- 3002 Dow Ave
Suite 204
Tustin, CA 92780-7233 - Phone
- (888) 277-0080
- NPI assigned
- Apr 14, 2011
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | A114369 | CA | Primary |
Addresses
Primary practice location
3002 Dow Ave
Suite 204
Tustin, CA 92780-7233
Mailing address
PO Box 1211
Rosemead, CA 91770-1015
Phone (786) 546-2870
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140331001223 | CA | Order and Referring Only - Internal Medicine | 3779714076 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A114369 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302739200000",
"number": "1194015891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1211",
"city": "ROSEMEAD",
"state": "CA",
"postal_code": "917701015",
"telephone_number": "786-546-2870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3002 DOW AVE",
"address_2": "SUITE 204",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927807233",
"telephone_number": "888-277-0080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "PATRICK",
"middle_name": "ELVIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-04-14",
"last_updated": "2011-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "A114369",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.