Jack Douglas Clark, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

G56196 Issued in CA

Practice address

7112 N Fresno St
Suite 100
Fresno, CA 93720-2940

Phone

(559) 439-1620

Fax

(559) 432-6579

NPI assigned

Feb 5, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 CA

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

Ophthalmology

Education

University of Southern California Keck School of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Camarena HealthGroup PAC ID 4880584317, 79 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: jack.clark.1@17661.direct.athenahealth.com
• Direct secure messaging: jack.clark.p1@direct.californiaeye.nextgenshare.com
• Direct secure messaging: jack.clark.p4@direct.californiaeye.nextgenshare.com

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.

• Camarena Health

  • Federally Qualified Health Center (FQHC)
  • Madera, CA
  • NPI 1891778114
  Medicare reassignment Care Compare group NPD
• Eye Medical Clinic of Fresno, Inc.

  • Ophthalmology Physician
  • Fresno, CA
  • NPI 1659388700
  Medicare reassignment NPD
• Fogg Remington Eyecare Inc

  • Ophthalmology Physician
  • Fresno, CA
  • NPI 1023070869
  Medicare reassignment NPD
• Camarena Health

  dba Camarena Health - Los Banos

  • Federally Qualified Health Center (FQHC)
  • Los Banos, CA
  • NPI 1114757754
  NPD
• Camarena Health

  • Federally Qualified Health Center (FQHC)
  • Madera, CA
  • NPI 1124533492
  NPD
• Eye Medical Clinic of Fresno, Inc

  • Ophthalmology Physician
  • Fresno, CA
  • NPI 1306853452
  NPD
• Fogg Remington Eyecare Inc

  • Ophthalmology Physician
  • Fresno, CA
  • NPI 1437971082
  NPD
• United Health Centers of the San Joaquin Valley

  • Federally Qualified Health Center (FQHC)
  • Huron, CA
  • NPI 1134101686
  NPD (past)

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265571608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7112 N FRESNO ST",
            "address_2": "SUITE 100",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202940",
            "telephone_number": "559-439-1620",
            "fax_number": "559-432-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7112 N FRESNO ST",
            "address_2": "SUITE 100",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202940",
            "telephone_number": "559-439-1620",
            "fax_number": "559-432-6579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JACK",
        "middle_name": "DOUGLAS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G56196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G561960",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana Marie Clark
• David P. Clark, DDS, MS
• Gregory Reinaldo Clark, COUNSELOR
• Haylee Clark
• Jack Clark
• Jaycee Clark
• Jhinnae Clark
• John Gregory Clark, D.C.
• Kayla Nicole Clark
• Lauren Lya Clark, PHARMD

• Ophthalmology Physician in Fresno, CA
• Providers in Fresno, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.