Timothy A Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

15011 Double Bridges CT
Glenelg, MD 21737-9618

Phone

(443) 534-6487

NPI assigned

Dec 19, 2022

Last updated

Dec 19, 2022By 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

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• First Call Medical Center LLC

  • Urgent Care Clinic/Center
  • Burtonsville, MD
  • NPI 1922877851

  DC

  Medicare reassignment NPD
• Centennial Medical Group, PA

  • Family Medicine Physician
  • Columbia, MD
  • NPI 1134235039
  Medicare reassignment
• First Call Medical Center LLC

  dba First Call Urgent Care

  • Urgent Care Clinic/Center
  • Laurel, MD
  • NPI 1841680766
  Medicare reassignment
• Centennial Medical Group, PA

  • Physical Therapy Clinic/Center
  • Elkridge, MD
  • NPI 1477338325
  NPD
• First Call Medical Center LLC

  • Urgent Care Clinic/Center
  • Columbia, MD
  • NPI 1962269845
  NPD

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1336851724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15011 DOUBLE BRIDGES CT",
            "city": "GLENELG",
            "state": "MD",
            "postal_code": "217379618",
            "telephone_number": "443-534-6487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15011 DOUBLE BRIDGES CT",
            "city": "GLENELG",
            "state": "MD",
            "postal_code": "217379618",
            "telephone_number": "443-534-6487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TIMOTHY",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-12-19",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenny Barajas
• Caremotion Transport LLC
• Margaret Eileen Condon, CCC-SLP
• Wendy Cara Daulat, D.D.S
• Delta Neurodiagnostic Inc
• Amar Ghodasara, PHARMD
• Joel Goodman, DDS

• Physician Assistant in Glenelg, MD
• Providers in Glenelg, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.