NPIMap

Individual provider Active NPI

Jay Bradford Clark, DSCPT, MPT

  • Orthopedic Physical Therapist
  • Baltimore, MD
National Provider Identifier
1235255837
Registry record updated Jul 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
18491 Issued in MD
Practice address
4807 Benson Ave.
Baltimore, MD 21227-1530
Phone
(410) 242-8963
Fax
(410) 242-8965
NPI assigned
Mar 22, 2007
Last updated
Jul 17, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2009

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 18491 MD
Geriatric Physical Therapist 2251G0304X 18491 MD
Pediatric Physical Therapist 2251P0200X 18491 MD
Orthopedic Physical Therapist 2251X0800X 18491 MD Primary

Addresses

Primary practice location

4807 Benson Ave.
Baltimore, MD 21227-1530

Mailing address

4807 Benson Ave.
Baltimore, MD 21227-1530
Phone (410) 242-8963

Other identifiers 1

IdentifierTypeStateIssuer
020880900MedicaidMD

Other names 1

  • Dr. Bradford J. Clark Professional name

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

State licenses

LicenseStateTypeSpecialty
18491MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Accurate Rehab Technologies Past Accepting new patients
SPRC, LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247788800000",
    "number": "1235255837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4807 BENSON AVE.",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212271530",
            "telephone_number": "410-242-8963",
            "fax_number": "410-242-8965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4807 BENSON AVE.",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212271530",
            "telephone_number": "410-242-8963",
            "fax_number": "410-242-8965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JAY",
        "middle_name": "BRADFORD",
        "name_prefix": "Dr.",
        "credential": "DSCPT, MPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2009-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MD",
            "license": "18491",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "MD",
            "license": "18491",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MD",
            "license": "18491",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MD",
            "license": "18491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020880900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRADFORD",
            "last_name": "CLARK",
            "middle_name": "J.",
            "prefix": "DR.",
            "credential": "DSCPT, MPT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.