Jason A Clark, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

64521 Issued in GA

Practice address

3200 Downwood Cir NW
Suite 360
Atlanta, GA 30327-1610

Phone

(770) 405-9956

NPI assigned

Aug 29, 2008

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

Medicare fee-for-service enrollment

Enrolled in GA, ND2 enrollments

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 2

Specialty

Dermatology

Education

Duke University School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• Clark Laser & Cosmetic Dermatology, LLC

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1528425360
  Medicare reassignment NPD Authorized official
• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924
  Medicare reassignment NPD
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1528009412
  NPD

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453680000000",
    "number": "1295983427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 10TH ST NW UNIT 901",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093867",
            "telephone_number": "770-873-9956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 DOWNWOOD CIR NW",
            "address_2": "SUITE 360",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303271610",
            "telephone_number": "770-405-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JASON",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-29",
        "last_updated": "2016-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "64521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Monique Clark, NCC
• Doren Louise Clark, NURSE PRACTITIONER
• Jabari Clark
• James Andrew Clark, M.D.
• Janelle Clark
• Javeya Clark, OD
• Jeffrey Ira Clark, MD
• Jessica Taylor Clark, PT, DPT
• Johanna J Clark, CSA
• Julia Clark, LMSW

• Dermatology Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; 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.