NPIMap

Individual provider Active NPI

James Paul Clark II, MD

  • Allergy & Immunology Physician
  • Charleston, WV
National Provider Identifier
1306838453
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
17504 Issued in WV
Practice address
3411A Noyes Ave SE
Charleston, WV 25304
Phone
(304) 344-2459
Fax
(304) 345-1336
NPI assigned
Aug 16, 2005
Last updated
Oct 24, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 17504 WV Primary
Allergy Physician 207KA0200X 17504 WV

Addresses

Primary practice location

3411A Noyes Ave SE
Charleston, WV 25304

Mailing address

3411A Noyes Ave SE
Charleston, WV 25304
Phone (304) 344-2459

Other practice location 1

3977 Teays Valley Rd
Hurricane, WV 25526-9082
Phone (304) 344-2459

Other identifiers 3

IdentifierTypeStateIssuer
0079196000MedicaidWV
001722434OtherWVBLUE CROSS BS
5720204OtherWVAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090622000148 WV Practitioner - Allergy/Immunology 1658422308 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
JC Edwards School of Medicine, Marshall University, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thrush and Clark Allergists PLLCGroup PAC ID 3870644511, 2 clinicians

Practice addresses (Care Compare)

3415 Virginia Ave SE
Charleston, WV 25304-1308
Phone (304) 344-2459

Hospital & facility affiliations

National Provider Directory

National Provider Directory
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

OrganizationSpecialtyStatusNew patients
Thrush & Clark Allergists PLLC Allergy & Immunology CurrentSince Jan 1, 2000 Accepting new patients

Locations

3415 Virginia Ave SE
Charleston, WV 25304
Phone (304) 344-2459

3977 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 344-2459

Organizations & group practices 1

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540339200000",
    "number": "1306838453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3411A NOYES AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "25304",
            "telephone_number": "304-344-2459",
            "fax_number": "304-345-1336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411A NOYES AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "25304",
            "telephone_number": "304-344-2459",
            "fax_number": "304-345-1336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3977 Teays Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Hurricane",
            "state": "WV",
            "postal_code": "255269082",
            "country_code": "US",
            "telephone_number": "304-344-2459",
            "fax_number": "304-345-1336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JAMES",
        "middle_name": "PAUL",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2018-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "WV",
            "license": "17504",
            "primary": true
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "WV",
            "license": "17504",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0079196000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BS",
            "identifier": "001722434",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5720204",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.