Brian M Clark, MD
Individual provider Active NPI Reproductive Endocrinology Physician · Millbury, MA
NPI 1437159795 · NPPES record last updated Mar 1, 2021
Key facts
- NPI
- 1437159795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Reproductive Endocrinology Physician 207VE0102X
- License
- 226853 (MA)
- Practice address
- 22 West St Ste 25
Millbury, MA 01527-2677 - Phone
- (508) 917-6720
- Fax
- (508) 917-6721
- NPI assigned
- Jul 28, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- University of Vermont College of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
22 W St
Suite 25
Millbury, MA 01527-2677
Phone (508) 917-6720
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of the uterus | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060125000788 | MA | Practitioner - Obstetrics/Gynecology | 9335163609 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New England Reproductive Medicine and Surgery LLC | Reproductive Endocrinology | Current |
Accepting new patients |
| Umass Memorial Medical Group Inc | Past | Accepting new patients |
Locations
22 West St
Ste 25
Millbury, MA 01527
Phone (508) 917-6720
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Reproductive Endocrinology Physician | 207VE0102X | 226853 | MA | Yes |
Addresses
Primary practice location
22 West St Ste 25
Millbury, MA 01527-2677
Mailing address
22 West St Ste 25
Millbury, MA 01527-2677
Phone (508) 917-6720
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2112191 | Medicaid | MA |
Other providers in Millbury, MA
- Pauline Cerone
- Emily Chang
- Ifeyinwa Charles-George
- Richard Sylvester Chiaravalloti
- Amanda Marie Ciejka
- Laura Collins
- Connection Guardianship of Ma, Inc
- Sydney Corridori
- Counseling Center at Millbury LLC
- Karri A. Crowley
All providers in Millbury, MA · Reproductive Endocrinology Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.