Scott Clark, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA3724 Issued in FL

Practice address

1503 Buenos Aires Blvd Ste 100
The Villages, FL 32159-6825

Phone

(352) 753-2812

Fax

(352) 753-0537

NPI assigned

Aug 30, 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 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Leavitt Medical Associates of Florida IncGroup PAC ID 4688579311, 199 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Leavitt Medical Associates of Florida Inc

  • Dermatology Physician
  • Sebastian, FL
  • NPI 1083872535
  Medicare reassignment Care Compare group NPD
• Cardiovascular Surgeons, P.a.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Orlando, FL
  • NPI 1912904111
  NPD (past)
• Florida Hospital Medical Group Inc

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1225034234

  Physician Assistant

  NPD (past)
• Leavitt Medical Associates of Florida Inc

  • Dermatology Physician
  • Orlando, FL
  • NPI 1316105885
  NPD (past)
• Leavitt Medical Associates of Florida Inc

  • Dermatology Physician
  • Heathrow, FL
  • NPI 1528097284
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1255440475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "407-875-2080",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 BUENOS AIRES BLVD STE 100",
            "city": "THE VILLAGES",
            "state": "FL",
            "postal_code": "321596825",
            "telephone_number": "352-753-2812",
            "fax_number": "352-753-0537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 W Granada Blvd Ste 44",
            "address_purpose": "LOCATION",
            "city": "Ormond Beach",
            "state": "FL",
            "postal_code": "321749406",
            "country_code": "US",
            "telephone_number": "386-898-0547",
            "fax_number": "386-898-0551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2893 Enterprise Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Debary",
            "state": "FL",
            "postal_code": "327132784",
            "country_code": "US",
            "telephone_number": "386-789-8600 x38678",
            "fax_number": "386-789-0219",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1918 SE 17th St # 300",
            "address_purpose": "LOCATION",
            "city": "Ocala",
            "state": "FL",
            "postal_code": "344714120",
            "country_code": "US",
            "telephone_number": "352-620-2420",
            "fax_number": "352-620-2935",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1816 Salk Ave",
            "address_purpose": "LOCATION",
            "city": "Tavares",
            "state": "FL",
            "postal_code": "327784300",
            "country_code": "US",
            "telephone_number": "352-343-2461",
            "fax_number": "352-343-5968",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 W Plymouth Ave",
            "address_purpose": "LOCATION",
            "city": "Deland",
            "state": "FL",
            "postal_code": "327203260",
            "country_code": "US",
            "telephone_number": "386-738-8000",
            "fax_number": "386-738-0929",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SCOTT",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300867600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimmel R Chisolm, D.C.
• Cim Medical Group Inc
• Barbara Cingel, MD
• CL Medical Group Inc
• James Butch Clark, PT
• Timothy Adam Clarrey, D.C.
• Clear View Optix, LLC
• Clermont Center for Comprehensive Dentistry
• Michael E Clifford, MD
• Clinical Pet of Ocala LLC

• Physician Assistant in The Villages, FL
• Providers in The Villages, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.