Active NPI
James E Clark, MD
- Family Medicine Physician
- Enumclaw, WA
National Provider Identifier
1336159482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD00013526
- Practice address
- 3021 Griffin Ave
Enumclaw, WA 98022-2369 - Phone
- (360) 825-6511
- Fax
- (360) 825-6536
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00013526 | WA | Primary |
Addresses
Primary practice location
3021 Griffin Ave
Enumclaw, WA 98022-2369
Mailing address
3021 Griffin Ave
Enumclaw, WA 98022-2369
Phone (360) 825-6511
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1062207 | Medicaid | WA | |
| 8928598 | Other | WA | STATE CRIME VICTIMS |
| 126689 | Other | WA | STATE L&I |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203638400000",
"number": "1336159482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3021 GRIFFIN AVE",
"city": "ENUMCLAW",
"state": "WA",
"postal_code": "980222369",
"telephone_number": "360-825-6511",
"fax_number": "360-825-6536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3021 GRIFFIN AVE",
"city": "ENUMCLAW",
"state": "WA",
"postal_code": "980222369",
"telephone_number": "360-825-6511",
"fax_number": "360-825-6536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JAMES",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2008-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD00013526",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1062207",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE CRIME VICTIMS",
"identifier": "8928598",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "126689",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Enumclaw, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.