Jeffrey G Clark, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

13241 Issued in MS

Practice address

425 Highway 51 N
Brookhaven, MS 39601-2350

Phone

(601) 833-5713

Fax

(601) 833-1616

NPI assigned

Sep 22, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Urology

Education

University of Alabama School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brookhaven Urology, PA 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• King'S Daughters Medical Center-Brookhaven Hospital, Brookhaven, MS, CCN 250057

Merit-based Incentive Payment System (MIPS)

Final score

89.86 of 100Reported as group

Quality

79.72

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/uc06681_brookhavenurology
• Direct secure messaging: jeffreyclark@bhav.medalliesdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brookhaven Urology, PA

  • Urology Physician
  • Brookhaven, MS
  • NPI 1154421006

  MS, Urology

  Medicare reassignment Care Compare group NPD

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

• King'S Daughters Medical Center

  • General Acute Care Hospital
  • Brookhaven, MS
  • NPI 1972503464

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376643247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 HIGHWAY 51 N",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012350",
            "telephone_number": "601-833-5713",
            "fax_number": "601-833-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 HIGHWAY 51 N",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012350",
            "telephone_number": "601-833-5713",
            "fax_number": "601-833-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JEFFREY",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MS",
            "license": "13241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00116404",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Corey Case, MD
• Amanda Chappell, NP
• Robert Dean Chappell Jr., FNP-C
• Paige V Chisolm, NP
• Chloe'S Caring Hands Healthcare LLC
• Candice Nicole Cliburn, NURSE PRACTITIONER
• Clint'S Pharmacy Inc
• Crystal Alane Cloy, PMHNP
• Dominique Collins
• Tiffany P Collins, ADMINISTRATOR

• All providers in Brookhaven, MS
• Urology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.