Individual provider Active NPI

Christine Nguyen Clarke, DO, MA

  • Pediatric Hematology & Oncology Physician
  • Orlando, FL
National Provider Identifier
1265936488
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
OS21358 Issued in FL
Practice address
2501 N Orange Ave Ste 589
Orlando, FL 32804-4647
Phone
(407) 303-2080
NPI assigned
Mar 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 125.071923 IL
Pediatrics Physician 208000000X 036.155899 IL
Pediatric Hematology & Oncology Physician 2080P0207X OS21358 FL Primary

Addresses

Primary practice location

2501 N Orange Ave Ste 589
Orlando, FL 32804-4647

Mailing address

2501 N Orange Ave Ste 589
Orlando, FL 32804-4647
Phone (407) 303-2080

Other practice location 1

225 E Chicago Ave
Chicago, IL 60611-2991
Phone (951) 422-0376

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240927000991 FL Practitioner - Hematology/Oncology 3577094820 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Master of Arts

State licenses

LicenseStateTypeSpecialty
036.155899ILMDPediatrics Physician
125.071923ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc CurrentSince Oct 7, 2024 Accepting new patients
Florida Hospital Medical Group Inc Pediatrics CurrentSince Oct 7, 2024 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

2501 N Orange Ave
Ste 589
Orlando, FL 32804
Phone (407) 303-1300

Interoperability endpoints

  • Direct secure messaging: cclarke3745337@adventhealth.direct-ci.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1265936488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 N ORANGE AVE STE 589",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328044647",
            "telephone_number": "407-303-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 N ORANGE AVE STE 589",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328044647",
            "telephone_number": "407-303-2080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 E Chicago Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606112991",
            "country_code": "US",
            "telephone_number": "951-422-0376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "CHRISTINE",
        "middle_name": "NGUYEN",
        "credential": "DO, MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-21",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125.071923",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036.155899",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "FL",
            "license": "OS21358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.