NPIMap

Individual provider Active NPI

Clark D Baker III, MD

  • Cardiovascular Disease Physician
  • Pell City, AL
National Provider Identifier
1326034836
Registry record updated Nov 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
21072 Issued in AL
Practice address
2805 Dr John Haynes Dr
Pell City, AL 35125-1448
Phone
(205) 814-2104
Fax
(205) 814-2145
NPI assigned
Sep 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 21072 AL Primary
Emergency Medicine Physician 207P00000X 21072 AL
Internal Medicine Physician 207R00000X 21072 AL

Addresses

Primary practice location

2805 Dr John Haynes Dr
Pell City, AL 35125-1448

Mailing address

PO Box 11407
Lockbox 1061
Birmingham, AL 35246-1061
Phone (205) 437-6098

Other identifiers 3

IdentifierTypeStateIssuer
051522553OtherALBCBS
051522553MedicaidAL
051540582OtherALBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21072ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Demopolis Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Southwest Alabama Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Carraway Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Fayette Medical Center Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226966400000",
    "number": "1326034836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "address_2": "LOCKBOX 1061",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352461061",
            "telephone_number": "205-437-6098",
            "fax_number": "205-437-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 DR JOHN HAYNES DR",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351251448",
            "telephone_number": "205-814-2104",
            "fax_number": "205-814-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "CLARK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2008-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AL",
            "license": "21072",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "21072",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "21072",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051522553",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051522553",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051540582",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pell City, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2008; 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.