Gordon Blake Clark, MD

Primary specialty

Obesity Medicine (Obstetrics & Gynecology) PhysicianTaxonomy code 207VB0002X

License

04-23518 Issued in KS

Practice address

21624 Midland Dr
Shawnee, KS 66218-9064

Phone

(913) 643-0075

Fax

(913) 643-0077

NPI assigned

Jan 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

University of Kansas School of Med (KC/Wich/Sal), 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: womensfamilycare.gordonclark@152829.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Comprehensive Women's Care, Inc.

  dba Women's & Family Care

  • Family Nurse Practitioner
  • Shawnee, KS
  • NPI 1790852135

  Obstetrics & Gynecology

  Medicare reassignment NPD Authorized official
• Stormont-Vail Pharmacy, LLC

  dba Stormont Vail Retail Pharmacy

  • Community/Retail Pharmacy
  • Topeka, KS
  • NPI 1225124357
  NPD (past)
• The Headache & Pain Center, P. a.

  • Ambulatory Surgical Clinic/Center
  • Overland Park, KS
  • NPI 1972570414
  NPD (past)
• University Health Physicians

  • Internal Medicine Physician
  • Kansas City, MO
  • NPI 1669456257

  Obstetrics & Gynecology

  NPD (past)

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1417937145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21624 MIDLAND DR",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662189064",
            "telephone_number": "913-643-0075",
            "fax_number": "913-643-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21624 MIDLAND DR",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662189064",
            "telephone_number": "913-643-0075",
            "fax_number": "913-643-0077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GORDON",
        "middle_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "KS",
            "license": "KS 04-23518",
            "primary": false
        },
        {
            "code": "207VB0002X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obesity Medicine",
            "state": "KS",
            "license": "04-23518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100305190D",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chiropractic Pain Clinic
• Jenny Grace Cho, M.D.
• Daniel Lawrence Christiansen, MD
• Bartholomew Chupka, PT
• Mary Denise Clanton, PTA
• Matthew Corbin Clark, LMSW
• Tina M Clark, LSCSW
• Tracy A Clark, ARNP
• Tucker Clark
• Barbara Gaye Cleverdon, LCMFT

• Obstetrics & Gynecology Physician in Shawnee, KS
• Providers in Shawnee, KS by specialty
• Obstetrics & Gynecology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.