Charles E Clark IV, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

0101053907 Issued in VA

Practice address

1900 Electric Rd
Salem, VA 24153-7474

Phone

(540) 772-7200

NPI assigned

Jul 19, 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

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

Brody School of Medicine at East Carolina University, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gate City Anesthesia, IncGroup PAC ID 8820089329, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Gate City Anesthesia, Inc

  • Pain Medicine (Anesthesiology) Physician
  • Greensboro, NC
  • NPI 1225135361
  Medicare reassignment Care Compare group NPD
• Surgical Center of Greensboro, LLC

  • Ambulatory Surgical Clinic/Center
  • Greensboro, NC
  • NPI 1245288257
  NPD

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202947200000",
    "number": "1194745851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13888",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240383888",
            "telephone_number": "540-772-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 ELECTRIC RD",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241537474",
            "telephone_number": "540-772-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLES",
        "middle_name": "E",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101053907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CHS, Inc
• Lindsey Chun, DMD
• Michal Carlyle Cieraszynski, D.O.
• City of Salem
• City of Salem Schools
• David R. Clark, PA-C
• Donald Hamilton Clark III, MD
• Jason Andrew Clark, CRNA
• Joe F Clark, M.D.
• Nathanael Bryant Clark, BEHAVIOR TECHNICIAN

• Anesthesiology Physician in Salem, VA
• Providers in Salem, VA by specialty
• Anesthesiology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; 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.
• 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.