Joe Clinkenbeard, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10000235 Issued in IN

Practice address

2421 Laporte Ave
Valparaiso, IN 46383-6914

Phone

(219) 462-6192

Fax

(219) 464-2585

NPI assigned

Jul 1, 2005

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• The Methodist Hospitals, Inc

  • Internal Medicine Physician
  • Gary, IN
  • NPI 1720290349
  NPD (past)

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337126400000",
    "number": "1306843685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 SIERRA DR",
            "address_2": "SUITE 400",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461437241",
            "telephone_number": "317-528-4252",
            "fax_number": "317-865-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 LAPORTE AVE",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463836914",
            "telephone_number": "219-462-6192",
            "fax_number": "219-464-2585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLINKENBEARD",
        "first_name": "JOE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2012-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10000235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM TRADITIONAL",
            "identifier": "000000721671",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Clark, NCC, LMHCA
• Claymoth LLC
• Alexis Renai Cleveland, LAT, ATC
• Angie Sue Cleveland, MSW
• Clinical Psychology Center, P.C.
• Bailey Coban, RBT
• Nicoletta Coduti, MS, RD
• Lindsey Cogdill
• Robert Tyrone Coican, RPH
• Jessica Coleman

• Physician Assistant in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; 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.