NPIMap

Individual provider Active NPI

Luke Samuel Clark, PA-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1417425240
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-08529 Issued in NC
Practice address
200 Hawthorne LN
Charlotte, NC 28204-2515
Phone
(704) 384-5600
NPI assigned
Nov 9, 2018
Last updated
Oct 26, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-08529 NC Primary

Addresses

Primary practice location

200 Hawthorne LN
Charlotte, NC 28204-2515

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-1246

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lclark683790@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181227000691 NC Practitioner - Physician Assistant 0446595185 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

3515 Whitehall Park Dr
Suite 300
Charlotte, NC 28273-4179

3545 Whitehall Park Dr
Suite 300
Charlotte, NC 28273-4179
Phone (980) 302-8850

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-08529NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cabarrus Rowan Community Health Centers, Inc. CurrentSince May 1, 2019 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 19, 2018 Accepting new patients
Cabarrus Rowan Community Health Centers, Inc. CurrentSince May 1, 2019 Accepting new patients
NMG Health Services LLC CurrentSince Mar 1, 2022 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 19, 2018 Accepting new patients
Novant Health Medical Group Coastal Region, LLC CurrentSince Mar 1, 2022 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Dec 28, 2021 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

1900 Randolph Rd
Ste 800
Charlotte, NC 28207
Phone (704) 941-4171

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

202D McGill Ave NW
Concord, NC 28025
Phone (704) 792-2242

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 11

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": "1541721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1417425240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-1246",
            "fax_number": "704-384-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-384-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LUKE",
        "middle_name": "SAMUEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-09",
        "last_updated": "2020-10-26",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lclark683790@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "200 Hawthorne Ln",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282042515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.