Active NPI
David D Clutts, M.D.
- Surgery Physician
- Carbondale, IL
National Provider Identifier
1407822406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 36-078587
- Practice address
- 2601 W Main St
Carbondale, IL 62901-1031 - Phone
- (618) 549-5361
- Fax
- (618) 549-5128
- NPI assigned
- Feb 28, 2006
- Last updated
- Jul 7, 2011
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 36-078587 | IL | Primary |
Addresses
Primary practice location
2601 W Main St
Carbondale, IL 62901-1031
Mailing address
PO Box 1105
Indianapolis, IN 46206-1105
Phone (618) 549-5361
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 027516 | Other | IL | HEALTH ALLIANCE |
| 3932056 | Other | IL | BCBS OF IL |
| 142410 | Other | IL | HEALTHLINK INSURANCE |
| 7210895 | Other | IL | AETNA |
| 036078587 | Medicaid | IL | |
| 20016640 | Other | IL | RR MEDICARE |
| 324130 | Other | IL | GHP |
| 42496 | Other | IL | GHP |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36-078587 | IL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309996800000",
"number": "1407822406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1105",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462061105",
"telephone_number": "618-549-5361",
"fax_number": "618-549-5128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 W MAIN ST",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011031",
"telephone_number": "618-549-5361",
"fax_number": "618-549-5128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLUTTS",
"first_name": "DAVID",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-28",
"last_updated": "2011-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "36-078587",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "027516",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF IL",
"identifier": "3932056",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK INSURANCE",
"identifier": "142410",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7210895",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036078587",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "20016640",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "324130",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "42496",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.