Individual provider Active NPI

Clarence M Harris, MD

  • Ophthalmology Physician
  • Orange Park, FL
National Provider Identifier
1275598526
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
ME0015120 Issued in FL
Practice address
2023 Professional Center Drive
Orange Park, FL 32073
Phone
(904) 272-2020
Fax
(904) 276-4386
NPI assigned
Apr 19, 2006
Last updated
Oct 24, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X ME0015120 FL Primary

Addresses

Primary practice location

2023 Professional Center Drive
Orange Park, FL 32073

Mailing address

2023 Professional Center Drive
Orange Park, FL 32073
Phone (904) 272-2020

Other identifiers 4

IdentifierTypeStateIssuer
CB1273OtherFLRAILROAD MEDICARE
1635739001OtherFLCIGNA
10075OtherFLBCBS
4047763OtherFLAETNA

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
I20080703000195 FL Practitioner - Ophthalmology 9436221892 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Miami, LM Miller School of Medicine, 1968
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Harris Wilcox and Donovan PAGroup PAC ID 4981776333, 17 clinicians

Practice addresses (Care Compare)

2023 Professional Ctr Dr
Orange Park, FL 32073-4472
Phone (904) 272-2020

Merit-based Incentive Payment System (MIPS)

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0015120FLMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harris Wilcox and Donovan PA Ophthalmology CurrentSince Dec 31, 1988 Accepting new patients
Harris Wilcox and Donovan PA Ophthalmology CurrentSince Dec 31, 1988 Accepting new patients

Locations

1855 Eastwest Pkwy
Fleming Isle, FL 32003

1658 St Vincents Way
Ste 250
Middleburg, FL 32068
Phone (703) 969-6229

1615 County Road 220
Ste 140
Orange Park, FL 32003
Phone (904) 276-2020

2023 Professional Center Dr
Orange Park, FL 32073
Phone 9042722020234

Interoperability endpoints

  • Direct secure messaging: charris@clayeye.emadirect.md

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": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1275598526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 PROFESSIONAL CENTER DRIVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "32073",
            "telephone_number": "904-272-2020",
            "fax_number": "904-276-4386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 PROFESSIONAL CENTER DRIVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "32073",
            "telephone_number": "904-272-2020",
            "fax_number": "904-276-4386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "CLARENCE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME0015120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB1273",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1635739001",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "10075",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4047763",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.