NPIMap

Individual provider Active NPI

Dennis Dewayne Clark, M.D.

  • Specialist
  • Anniston, AL
National Provider Identifier
1356313969
Registry record updated Jul 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
23397 Issued in AL
Practice address
111 Town Center Dr
Anniston, AL 36205-4101
Phone
(256) 237-1624
Fax
(256) 238-0555
NPI assigned
Feb 7, 2006
Last updated
Jul 28, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 23397 AL Primary

Addresses

Primary practice location

111 Town Center Dr
Anniston, AL 36205-4101

Mailing address

PO Box 5430
Anniston, AL 36205-0430
Phone (256) 237-1624

Other identifiers 3

IdentifierTypeStateIssuer
000097064MedicaidAL
51097064OtherALBLUE CROSS BLUE SHIELD
020048856OtherALUNITED HEALTHCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091116000027 AL Practitioner - General Surgery 6608914437 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Wake Forest University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Surgical Clinic of Anniston PAGroup PAC ID 2365337128, 6 clinicians

Practice addresses (Care Compare)

111 Town Ctr Dr
Anniston, AL 36205-4101
Phone (256) 241-1624

600 S 3Rd St
Gadsden, AL 35901-5304
Phone (256) 467-4731

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
26.98 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
89.93

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy182
Hernia repair - groin (open)22
Mastectomy26
Upper gastrointestinal (GI) endoscopy for acid reflux101
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
23397ALMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Healthcare Services-Gadsden Physician Management LLC CurrentSince Nov 15, 2024 Accepting new patients
The Surgical Clinic of Anniston, PA Specialist CurrentSince Jul 15, 2000 Accepting new patients
Intellimed Solutions, LLC Past Accepting new patients
Longleaf Primary Care, LLC PastSince Jun 26, 2022 Accepting new patients

Locations

111 Town Center Dr
Anniston, AL 36205
Phone (256) 237-1624

171 Town Center Dr
Anniston, AL 36205
Phone (256) 241-5470

171 Town Center Dr
Ste M1
Anniston, AL 36205

600 S 3rd St
Gadsden, AL 35901
Phone (256) 543-5200

1642A Pelham Rd S
Jacksonville, AL 36265
Phone (256) 543-1222

Interoperability endpoints

  • Direct secure messaging: dewayne.clark@nasa.directbygreenway.com
  • FHIR API: https://api.platform.athenahealth.com/10998/brand/1/csg/1/fhir/r4

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311811200000",
    "number": "1356313969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5430",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362050430",
            "telephone_number": "256-237-1624",
            "fax_number": "256-238-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 TOWN CENTER DR",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362054101",
            "telephone_number": "256-237-1624",
            "fax_number": "256-238-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DENNIS",
        "middle_name": "DEWAYNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2011-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "23397",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000097064",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51097064",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "020048856",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anniston, AL

Sources for this page

Verify at the official NPI Registry.