Active NPI
Darrel Christian Clark, DO
- Family Medicine Physician
- Grand Junction, CO
National Provider Identifier
1386668846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 26814
- Practice address
- 241 N. 4TH St.
# 331
Grand Junction, CO 81502-0331 - Phone
- (970) 409-9734
- NPI assigned
- Jul 27, 2006
- 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 | 26814 | CO | Primary |
Addresses
Primary practice location
241 N. 4TH St.
# 331
Grand Junction, CO 81502-0331
Mailing address
241 N. 4TH St.
Box 331
Grand Junction, CO 81502-0331
Phone (970) 409-9734
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CLO2552 | Other | CO | BCBS |
| 01268143 | Medicaid | CO | |
| 080038341 | Other | CO | RAIL ROAD MEDICARE |
Other names 1
- Dr. Chris Clark
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26814 | CO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263254400000",
"number": "1386668846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "241 N. 4TH ST.",
"address_2": "BOX 331",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "815020331",
"telephone_number": "970-409-9734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "241 N. 4TH ST.",
"address_2": "# 331",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "815020331",
"telephone_number": "970-409-9734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DARREL",
"middle_name": "CHRISTIAN",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2010-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "26814",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "CLO2552",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01268143",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "080038341",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CHRIS",
"last_name": "CLARK",
"prefix": "DR.",
"credential": "D.O.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Grand Junction, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.