Dustin Michael Clark, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

50872 Issued in TN

Practice address

1420 Tusculum Blvd
Laughlin Memorial Hospital
Greeneville, TN 37745

Phone

(423) 787-5000

NPI assigned

Jun 29, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  TN

  Medicare reassignment NPD

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501459200000",
    "number": "1285831644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MELROSE CIR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 TUSCULUM BLVD",
            "address_2": "LAUGHLIN MEMORIAL HOSPITAL",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "37745",
            "telephone_number": "423-787-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DUSTIN",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2017-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "50872",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RESIDENT IN TRAINING",
            "identifier": "39020000X",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric R Chlebisch, PA
• Athena Marie Church
• City Pharmacy Inc
• Lawrence Allan Claiborne, DVM
• Shannon Leigh Clark D/B/a Massage Matters, LMT
• Tenicia Clark, APN, FNP-C
• Sarah Clayton
• Diane Alexander Cleghorn, BSN
• John Kevin Clement, O.D.
• Madyson P Clements, DPT

• Emergency Medicine Physician in Greeneville, TN
• Providers in Greeneville, TN by specialty
• Emergency Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.