James Robert Clark, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

4571 Issued in OH

Practice address

125 Executive Dr
Suite 106
Marion, OH 43302

Phone

(740) 382-5133

Fax

(740) 383-2289

NPI assigned

Mar 19, 2007

Last updated

Apr 6, 2009By 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 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238976000000",
    "number": "1285758094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 EXECUTIVE DR",
            "address_2": "SUITE 106",
            "city": "MARION",
            "state": "OH",
            "postal_code": "43302",
            "telephone_number": "740-382-5133",
            "fax_number": "740-383-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 EXECUTIVE DR",
            "address_2": "SUITE 106",
            "city": "MARION",
            "state": "OH",
            "postal_code": "43302",
            "telephone_number": "740-382-5133",
            "fax_number": "740-383-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JAMES",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2009-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "4571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000333769",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4535225",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Marion Auditor (Marion City Fire Department)
• Elizabeth Jean Claborn, LISW, MSW
• Carol Janeece Claes, R.N.
• Dale Alan Claes, P.T.
• Ashley Clark
• Marjorie Clark, LSW
• Michael Clark
• Brad Allen Clarkson, OTR
• Karen Diane Clay
• Selena Rhea Clement

• Clinical Psychologist in Marion, OH
• Providers in Marion, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2009; 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.