Active NPI
Edwin Allen Clark, DPM
- Podiatrist
- Little Rock, AR
National Provider Identifier
1346213626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 89
- Practice address
- 1501 Aldersgate Rd
Little Rock, AR 72205-6611 - Phone
- (501) 224-1501
- Fax
- (501) 376-7065
- NPI assigned
- Feb 8, 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 89 | AR | Primary |
Addresses
Primary practice location
1501 Aldersgate Rd
Little Rock, AR 72205-6611
Mailing address
1501 Aldersgate Rd
Little Rock, AR 72205-6611
Phone (501) 224-1501
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 480017088 | Other | RR MEDICARE | |
| 56081 | Other | AR | FIRST SOURCE PPO |
| 56081 | Other | AR | BLUE CROSS SHIELD |
| 56081 | Other | AR | BCBS FEP |
| 56081 | Other | AR | BLUE ADVANTAGE |
| 109956017 | Medicaid | AR | |
| 56081 | Other | AR | HEALTH ADVANTAGE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 89 | AR | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309996800000",
"number": "1346213626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 ALDERSGATE RD",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722056611",
"telephone_number": "501-224-1501",
"fax_number": "501-376-7065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 ALDERSGATE RD",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722056611",
"telephone_number": "501-224-1501",
"fax_number": "501-376-7065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "EDWIN",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-08",
"last_updated": "2011-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "AR",
"license": "89",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "480017088",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST SOURCE PPO",
"identifier": "56081",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS SHIELD",
"identifier": "56081",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS FEP",
"identifier": "56081",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE ADVANTAGE",
"identifier": "56081",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "109956017",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ADVANTAGE",
"identifier": "56081",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.