Individual provider Active NPI

Jay L Clarke, MHS, PA-C

  • Physician Assistant
  • Arden, NC
National Provider Identifier
1275508285
Registry record updated Aug 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
103190 Issued in NC
Practice address
78 Long Shoals Rd
Arden, NC 28704-7782
Phone
(828) 684-0703
Fax
(828) 684-5344
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 103190 NC
Physician Assistant 363A00000X 103190 NC Primary

Addresses

Primary practice location

78 Long Shoals Rd
Arden, NC 28704-7782

Mailing address

78 Long Shoals Rd
Arden, NC 28704-7782
Phone (828) 684-0703

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040302000793 NC Practitioner - Physician Assistant 7315834561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Duke University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Skin Surgery Center PAGroup PAC ID 3173599479, 72 clinicians

Practice addresses (Care Compare)

1450 Professional Park Dr
Winston Salem, NC 27103-1300
Phone (336) 724-2434

78 Long Shoals Rd
Arden, NC 28704-7782
Phone (828) 684-0703

Merit-based Incentive Payment System (MIPS)

Final score
90.65 of 100Reported as group
Promoting interoperability
89
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Skin Surgery Center PA CurrentSince Aug 1, 2017 Accepting new patients

Locations

78 Long Shoals Rd
Arden, NC 28704
Phone (704) 684-0703

1450 Professional Park Dr
Winston Salem, NC 27103
Phone (336) 724-2434

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": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346112000000",
    "number": "1275508285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 LONG SHOALS RD",
            "city": "ARDEN",
            "state": "NC",
            "postal_code": "287047782",
            "telephone_number": "828-684-0703",
            "fax_number": "828-684-5344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 LONG SHOALS RD",
            "city": "ARDEN",
            "state": "NC",
            "postal_code": "287047782",
            "telephone_number": "828-684-0703",
            "fax_number": "828-684-5344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "JAY",
        "middle_name": "L",
        "credential": "MHS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2012-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "103190",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arden, NC

Sources for this page

Verify at the official NPI Registry.