Brock Stephen Clark, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

2022-01455 Issued in NC

Practice address

2001 Vail Ave
Charlotte, NC 28207-1248

Phone

(704) 304-5000

NPI assigned

Mar 26, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gastonia Physician Services PLLCGroup PAC ID 3870719602, 66 clinicians

Western Carolina Emergency Physicians, PLLCGroup PAC ID 8921171190, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Caromont Regional Medical Center Hospital, Gastonia, NC, CCN 340032
• Stanly Regional Medical Center Hospital, Albemarle, NC, CCN 340119

Merit-based Incentive Payment System (MIPS)

Final score

86.02 of 100Reported as group

Quality

78.32

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Gastonia Physician Services, PLLC

  • Emergency Medicine Physician
  • Gastonia, NC
  • NPI 1316367691

  Emergency Medicine, NC

  Medicare reassignment Care Compare group NPD
• Western Carolina Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Albemarle, NC
  • NPI 1134391758

  Emergency Medicine, NC

  Medicare reassignment Care Compare group NPD
• Emergency Medicine Physicians of Mecklenburg County, PLLC

  • Emergency Medicine Physician
  • Charlotte, NC
  • NPI 1912232182

  Emergency Medicine, NC

  Medicare reassignment NPD
• The Carolinas Emergency Group, PLLC

  • Emergency Medicine Physician
  • Dunn, NC
  • NPI 1477508836

  Emergency Medicine, NC

  Medicare reassignment NPD
• Gastonia Physician Services, PLLC

  • Emergency Medicine Physician
  • Belmont, NC
  • NPI 1104644004

  Emergency Medicine

  NPD

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

• Atrium Health Hospitals Inc

  • General Acute Care Hospital
  • Albemarle, NC
  • NPI 1104627926

  Hospital

  Care Compare affiliation
• Atrium Health Hospitals Inc

  • Psychiatric Hospital Unit
  • Albemarle, NC
  • NPI 1740081553

  Hospital

  Care Compare affiliation
• Gaston Memorial Hospital, Incorporated

  • General Acute Care Hospital
  • Gastonia, NC
  • NPI 1013918960

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1336600170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 E 37TH ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282051116",
            "telephone_number": "352-361-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VAIL AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071248",
            "telephone_number": "704-304-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BROCK",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-26",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2022-01455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Clark-Oliver, LPC
• Abigail Rose Clark
• Amy Wilson Clark, NP
• Brittany Alexis Clark, MSW
• Brittany J Clark
• Caroline Shaffner Clark, PA-C
• Chelsey Clark
• Christa Leigh Clark, PA
• Christian Clark, MD
• Cierra Clark

• All providers in Charlotte, NC
• Emergency Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.