NPIMap

Organization Active NPI

W Bruce Clark MD PC

  • Obstetrics & Gynecology Physician
  • Latham, NY
National Provider Identifier
1396959110
Registry record updated Feb 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
W BRUCE CLARK MD PC
Practice address
585 New Loudon Rd
Latham, NY 12110-5701
Phone
(518) 783-1472
Fax
(518) 783-1605
NPI assigned
May 10, 2007
Last updated
Feb 26, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2008

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

Authorized official

Name
Denise McNamara
Title
Medical Biller
Phone
(518) 783-1472

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X NY Primary

Addresses

Primary practice location

585 New Loudon Rd
Latham, NY 12110-5701

Mailing address

585 New Loudon Rd
Latham, NY 12110-5701
Phone (518) 783-1472

Other identifiers 4

IdentifierTypeStateIssuer
00798590MedicaidNY
01698282MedicaidNY
01866453MedicaidNY
02425116MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041108000166 NY Part B Supplier - Clinic/Group Practice 6608839162 Receives reassigned benefits from 18 practitioners
Practice locations: Latham, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0161396W Bruce Clark MD PC585 New Loudon Road, Latham, NY 12110Provider-performed microscopyFeb 7, 2027

National Provider Directory

National Provider Directory

Locations

585 New Loudon Rd
Latham, NY 12110
Phone (518) 783-1472

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203984000000",
    "number": "1396959110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 NEW LOUDON RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121105701",
            "telephone_number": "518-783-1472",
            "fax_number": "518-783-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 NEW LOUDON RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121105701",
            "telephone_number": "518-783-1472",
            "fax_number": "518-783-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W BRUCE CLARK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2008-02-26",
        "status": "A",
        "authorized_official_last_name": "MCNAMARA",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "MEDICAL BILLER",
        "authorized_official_telephone_number": "518-783-1472"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00798590",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01698282",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01866453",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02425116",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.