Active NPI
Gregory James Clark, MD
- Internal Medicine Physician
- Ankeny, IA
National Provider Identifier
1386730836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD-43163
- Practice address
- 800 E 1St St Ste 1700
Ankeny, IA 50021-2100 - Phone
- (515) 643-8100
- Fax
- (515) 643-8139
- NPI assigned
- Oct 4, 2006
- Last updated
- Jul 21, 2022
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD-43163 | IA | Primary |
Addresses
Primary practice location
800 E 1St St Ste 1700
Ankeny, IA 50021-2100
Mailing address
PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 643-8100
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942185 | Medicaid | IA | |
| 101225800 | Medicaid | MN | |
| 115522 | Other | MN | UCARE |
| 8T180CL | Other | MN | BCBS MPIN |
| 110164901 | Other | MN | RR MEDICARE |
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 Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinics Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1386730836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1475",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503051475",
"telephone_number": "515-643-8100",
"fax_number": "515-643-8139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E 1ST ST STE 1700",
"city": "ANKENY",
"state": "IA",
"postal_code": "500212100",
"telephone_number": "515-643-8100",
"fax_number": "515-643-8139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "GREGORY",
"middle_name": "JAMES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IA",
"license": "MD-43163",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1942185",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101225800",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "115522",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MPIN",
"identifier": "8T180CL",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "110164901",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ankeny, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.