Active NPI
Fred Clarke, MD
- Family Medicine Physician
- Jamaica, NY
National Provider Identifier
1346206950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 206376
- Practice address
- 20016 Hollis Avenue
Jamaica, NY 11412 - Phone
- (718) 736-8204
- Fax
- (718) 736-8505
- NPI assigned
- Apr 22, 2006
- Last updated
- Jan 18, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 | 206376 | NY | Primary |
Addresses
Primary practice location
20016 Hollis Avenue
Jamaica, NY 11412
Mailing address
80 Marcus Dr
Provider Enrollment
Melville, NY 11747-4230
Phone (631) 391-7889
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01862739 | Medicaid | NY |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 026376 | NY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TJH Medical Services, P.C. | Family Medicine | Past | Accepting new patients |
| TJH Medical Services, PC | Past | Accepting new patients | |
| JHMC Diagnostic and Treatment Center | Family Medicine | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Jamaica, NY
- NPI 1821045485
-
dba Jamaica Hospital Ambulatory Care Center
- Multi-Specialty Clinic/Center
- Jamaica, NY
- NPI 1588605802
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358467200000",
"number": "1346206950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 MARCUS DR",
"address_2": "PROVIDER ENROLLMENT",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117474230",
"telephone_number": "631-391-7889",
"fax_number": "631-454-4163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20016 HOLLIS AVENUE",
"city": "JAMAICA",
"state": "NY",
"postal_code": "11412",
"telephone_number": "718-736-8204",
"fax_number": "718-736-8505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "FRED",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-22",
"last_updated": "2013-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "206376",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01862739",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.