Stephen F Clack, PT,DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT012365 Issued in GA

Practice address

210 E Derenne Ave
Savannah, GA 31405-6736

Phone

(912) 644-5300

Fax

(912) 644-3369

NPI assigned

Jul 7, 2016

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

Medicare fee-for-service enrollment

Enrolled in GA, SC2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optim Orthopedics LLCGroup PAC ID 9931427002, 101 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stephen.clack.1@16403.direct.athenahealth.com

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.

• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Bluffton, SC
  • NPI 1528451481
  Medicare reassignment Care Compare group NPD
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Savannah, GA
  • NPI 1780077982
  Medicare reassignment
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Richmond Hill, GA
  • NPI 1548653330
  NPD
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Midway, GA
  • NPI 1821639758
  NPD (past)

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

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486944000000",
    "number": "1194177766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 MALL BLVD",
            "address_2": "SUITE B",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314064801",
            "telephone_number": "912-644-5300",
            "fax_number": "912-644-3369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E DERENNE AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056736",
            "telephone_number": "912-644-5300",
            "fax_number": "912-644-3369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLACK",
        "first_name": "STEPHEN",
        "middle_name": "F",
        "credential": "PT,DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-07",
        "last_updated": "2017-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT012365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cintex Injury Clinic LLC
• Circle of Friends Counseling & Consulting LLC
• Tadeusz Ciszak, M.D.
• Kacey Civitella
• CJ Transportation Service LLC
• Clarafaith Home Health
• Clark Chiropractic and Wellness Care, LLC
• Tracey Amanda Clark-Johnson
• Alexandra Nicole Clark
• Carly Virginia Clark

• Physical Therapist in Savannah, GA
• Providers in Savannah, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.