Justin Clark, BOCO

Primary specialty

OrthotistTaxonomy code 222Z00000X

Practice address

1844 South St
Redding, CA 96001-1809

Phone

(530) 243-4500

Fax

(530) 243-4554

NPI assigned

Feb 28, 2018

Last updated

Mar 17, 2018By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Spectrum Prosthetics & Orthotics of Redding Inc

  • Prosthetic/Orthotic Supplier
  • Redding, CA
  • NPI 1639173537
  NPD (past)
• Spectrum Prosthetics & Orthotics of Redding, Inc.

  • Prosthetic/Orthotic Supplier
  • Red Bluff, CA
  • NPI 1013173848
  NPD (past)

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1285136846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1844 SOUTH ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011809",
            "telephone_number": "530-243-4500",
            "fax_number": "530-243-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1844 SOUTH ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011809",
            "telephone_number": "530-243-4500",
            "fax_number": "530-243-4554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1399 Montgomery Rd",
            "address_purpose": "LOCATION",
            "city": "Red Bluff",
            "state": "CA",
            "postal_code": "960804604",
            "country_code": "US",
            "telephone_number": "530-528-2200",
            "fax_number": "530-528-2290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JUSTIN",
        "credential": "BOCO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-28",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GFC000180",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "PG0073849001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taryn Marina Clapp
• Bethany Clark
• Eric J Clark
• Helen L. Clark, MFT
• John Charles Clark, M.D.
• Kathleen Jean Clark
• Kenneth L Clark, RN
• L. Ross Clark, M.D.
• Lon Thomas Clark, MFT
• Ryan J Clark

• Orthotist in Redding, CA
• Providers in Redding, CA by specialty
• Orthotist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.