Brian D. Clark, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA04747 Issued in TX

Practice address

601 N Frio St
San Antonio, TX 78207-3011

Phone

(210) 261-3750

Fax

(210) 444-1474

NPI assigned

Jun 13, 2006

Last updated

Jul 21, 2015By the provider in NPPES

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

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Bexar County Board of Trustees for Mental Health Mental Retardation

  dba The Center for Health Care Services

  • Counselor
  • San Antonio, TX
  • NPI 1730134586
  Medicare reassignment

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437436800000",
    "number": "1306889944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 W IH 10",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782015159",
            "telephone_number": "210-261-1000",
            "fax_number": "210-731-8678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N FRIO ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782073011",
            "telephone_number": "210-261-3750",
            "fax_number": "210-444-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRIAN",
        "middle_name": "D.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2015-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA04747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST. LICENSE",
            "identifier": "PA04747",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alecia Rattigan Clark, OTR
• Alexis Violet Clark
• Anthony Elmore Clark, M.D.
• Arthur Len Clark, C.P.L.P.
• Austin Clark
• Catherine Mary Clark, M.A.T., BCBA
• Cecelia Marie Clark
• Charles Lee Clark, DDS
• Charley Clark, COTA
• Clayton Lohiau Clark, DC

• Medical Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; 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.