Nicholas Samuel Clark, M.D.

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

0101264909 Issued in VA

Practice address

2331 Franklin Rd SW
Roanoke, VA 24014-1111

Phone

(540) 224-5170

Fax

(540) 344-2950

NPI assigned

Apr 15, 2014

Last updated

Dec 10, 2020By 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 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

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

Pain Management

Education

University of Virginia School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Carilion Medical CenterGroup PAC ID 9830096585, 956 clinicians

Oandw EnterprisesGroup PAC ID 6608927298, 216 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carilion Medical Center Hospital, Roanoke, VA, CCN 490024
• Carilion Franklin Memorial Hospital Hospital, Rocky Mount, VA, CCN 490089

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Carilion Medical Center

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1730123472
  Medicare reassignment Care Compare group NPD
• O&W Enterprises

  • Physical Therapist
  • Stanleytown, VA
  • NPI 1487895348
  Care Compare group
• Carilion Medical Center

  dba Carilion Clinic - DME - Westlake

  • Durable Medical Equipment & Medical Supplies
  • Hardy, VA
  • NPI 1073324810
  NPD
• Carilion Medical Center

  dba Carilion Roanoke Memorial Hospital

  • General Acute Care Hospital
  • Roanoke, VA
  • NPI 1033102942
  NPD (past)

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

• Carilion Franklin Memorial Hospital

  • General Acute Care Hospital
  • Rocky Mount, VA
  • NPI 1710970918
  Care Compare affiliation
• Carilion Medical Center

  dba Carilion Roanoke Memorial Hospital

  • General Acute Care Hospital
  • Roanoke, VA
  • NPI 1033102942
  Care Compare affiliation

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

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1356760508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2331 FRANKLIN RD SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240141111",
            "telephone_number": "540-224-5170",
            "fax_number": "540-344-2950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2331 FRANKLIN RD SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240141111",
            "telephone_number": "540-224-5170",
            "fax_number": "540-344-2950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICHOLAS",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-15",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "VA",
            "license": "0101264909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nclark48040@direct.carilionclinic.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "nclark48040@direct.carilionclinic.org",
            "address_1": "2331 Franklin Rd SW",
            "city": "Roanoke",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240141111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carolyn Clark, M.D.
• Christopher M Clark, LICENSED OPTICIAN
• Eric Clark, LCSW
• Jeffrey Dean Clark, D.D.S.
• Lynn Robinson Clark, DDS
• Robert Craig Clark III, MD
• Tracey Elizabeth Clark, MSW
• Clarissa Clarke, LMT
• Amber Jones Clary, NP
• James Lennon Claus, RBT

• Pain Medicine (Anesthesiology) Physician in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Pain Medicine (Anesthesiology) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.