George Thomas Clark III, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

32073 Issued in NC

Practice address

3713 Benson Drive, Suite 201
Carolina Vascular Surgery & Diagnostics, PA
Raleigh, NC 27609-7372

Phone

(919) 235-3400

Fax

(919) 235-3401

NPI assigned

Jun 8, 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 7

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

Vascular Surgery

Education

University of North Carolina at Chapel Hill School of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Duke University Hospital Hospital, Durham, NC, CCN 340030

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gclark49209@direct.medicine.duke.edu

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.

• Duke Health Integrated Practice, Inc.

  • General Practice Physician
  • Durham, NC
  • NPI 1205553369
  Medicare reassignment Care Compare group NPD
• The Vein Treatment Center, PA

  • Specialist
  • Raleigh, NC
  • NPI 1942413182
  NPD (past) Authorized official
• Wakemed Faculty Practice Plan

  • Pediatric Critical Care Medicine Physician
  • Raleigh, NC
  • NPI 1013203819
  NPD (past)
• Wakemed Faculty Practice Plan

  • Surgery Physician
  • Raleigh, NC
  • NPI 1396791786
  NPD (past)
• Wound Care Physicians PA

  • Specialist
  • Raleigh, NC
  • NPI 1881897395
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Duke University Health System Inc

  • Rehabilitation Hospital Unit
  • Raleigh, NC
  • NPI 1205225646
  Care Compare affiliation
• Duke University Health System Inc

  • Clinical Medical Laboratory
  • Raleigh, NC
  • NPI 1306828108

  Hospital

  Care Compare affiliation
• Duke University Health System Inc

  • Clinical Medical Laboratory
  • Durham, NC
  • NPI 1508847047

  Hospital

  Care Compare affiliation
• Duke University Health System, Inc.

  • Land Ambulance
  • Durham, NC
  • NPI 1417954942

  Hospital

  Care Compare affiliation
• Duke University Health System, Inc.

  • Rehabilitation Hospital Unit
  • Durham, NC
  • NPI 1538166061
  Care Compare affiliation
• Duke University Health System, Inc.

  • General Acute Care Hospital
  • Durham, NC
  • NPI 1992703540
  Care Compare affiliation

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328054400000",
    "number": "1215977889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3713 BENSON DRIVE",
            "address_2": "SUITE 201",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097372",
            "telephone_number": "919-235-3400",
            "fax_number": "919-235-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3713 BENSON DRIVE, SUITE 201",
            "address_2": "CAROLINA VASCULAR SURGERY & DIAGNOSTICS, PA",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097372",
            "telephone_number": "919-235-3400",
            "fax_number": "919-235-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GEORGE",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2012-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "32073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS MEDICARE",
            "identifier": "803254",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00016339",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE",
            "identifier": "3750391",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8922713",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "22713",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "424855",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "C6338",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Clark
• David A Clark, MD
• Doreen Elizabeth Clark, MS CCC-SLP
• Erika L. Clark, MD
• Faith Marrissa Clark, RPH.
• Jill Page Clark, COTA/L
• Jon Clark
• Juliana Jackson Clark, M.D.
• Karolina Ostapkiewicz Clark, C.P.O.
• Kendall Leigh Clark, PA-C

• Specialist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; 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.