Active NPI
Joseph Huston Clark, MD
- Pediatric Gastroenterology Physician
- Greensboro, NC
National Provider Identifier
1194773457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Gastroenterology Physician
- License
- 200500021
- Practice address
- 301 E Wendover Ave
Ste 311
Greensboro, NC 27401-1230 - Phone
- (336) 272-6161
- NPI assigned
- May 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 200500021 | NC | |
| Pediatric Gastroenterology Physician | 2080P0206X | 200500021 | NC | Primary |
Addresses
Primary practice location
301 E Wendover Ave
Ste 311
Greensboro, NC 27401-1230
Mailing address
301 E Wendover Ave
Ste 311
Greensboro, NC 27401-1230
Phone (336) 272-6161
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5900510 | Medicaid | NC | |
| 1386T | Other | NC | BCBS NC |
| 4304710 | Other | NC | AETNA |
| B1041 | Other | NC | MEDCOST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200500021 | NC | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365984000000",
"number": "1194773457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 E WENDOVER AVE",
"address_2": "STE 311",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274011230",
"telephone_number": "336-272-6161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 E WENDOVER AVE",
"address_2": "STE 311",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274011230",
"telephone_number": "336-272-6161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JOSEPH",
"middle_name": "HUSTON",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2013-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "200500021",
"primary": false
},
{
"code": "2080P0206X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": "NC",
"license": "200500021",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5900510",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "1386T",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4304710",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "B1041",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.