NPIMap

Individual provider Active NPI

William Bruce Clark, MD

  • Obstetrics & Gynecology Physician
  • Latham, NY
National Provider Identifier
1235202599
Registry record updated Oct 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
114221 Issued in NY
Practice address
585 Lew Loudon Road
Latham, NY 12110-5701
Phone
(518) 783-1472
Fax
(518) 783-1605
NPI assigned
Nov 16, 2006
Last updated
Oct 3, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 114221 NY Primary

Addresses

Primary practice location

585 Lew Loudon Road
Latham, NY 12110-5701

Mailing address

585 Lew Loudon Road
Latham, NY 12110-5701
Phone (518) 783-1472

Other identifiers 1

IdentifierTypeStateIssuer
00798590MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041122000730 NY Practitioner - Obstetrics/Gynecology 6800859224 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1971
Medicare assignment
May accept Medicare assignment
Group practices
W Bruce Clark MD PCGroup PAC ID 6608839162, 5 clinicians

Practice addresses (Care Compare)

585 New Loudon Rd
Latham, NY 12110-5701
Phone (518) 783-1472

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
W Bruce Clark MD PC Obstetrics & Gynecology CurrentSince Dec 1, 1983 Accepting new patients
New York Nephrology and Dialysis Access Surgery, P.C. CurrentSince Nov 10, 2022 Accepting new patients
Lee and Burack OB/GYN, P.C. Obstetrics & Gynecology CurrentSince Nov 10, 2022 Accepting new patients
Robert H Dropkin MD Laura a Costello MD OB-GYN LLP Obstetrics & Gynecology CurrentSince Nov 10, 2022 Accepting new patients
Albany Medical Center Hospital Past Accepting new patients
St. Peter's Hospital of the City of Albany Past Accepting new patients
St. Peter's Hospital of the City of Albany Past Accepting new patients

Locations

62 Hackett Blvd
Albany, NY 12209
Phone (518) 434-2244

585 New Loudon Rd
Latham, NY 12110
Phone (518) 783-1472

6 Executive Park Dr
Stuyvesant Plaza, NY 12203
Phone (518) 482-9111

258 Hoosick St
Ste 204
Troy, NY 12180
Phone (518) 272-4231

Interoperability endpoints

  • Direct secure messaging: wbclark@wbruceclarkmdpc.medentdirect.com
  • Direct secure messaging: wclark835209@direct.trinity-health.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317600000000",
    "number": "1235202599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 LEW LOUDON ROAD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121105701",
            "telephone_number": "518-783-1472",
            "fax_number": "518-783-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 LEW LOUDON ROAD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121105701",
            "telephone_number": "518-783-1472",
            "fax_number": "518-783-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "WILLIAM",
        "middle_name": "BRUCE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2011-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "114221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00798590",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

Verify at the official NPI Registry.