Active NPI
Wellsboro Pediatric Health Care Associates
- Pediatrics Physician
- Wellsboro, PA
National Provider Identifier
1437210325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD029130E
- Legal business name
- WELLSBORO PEDIATRIC HEALTH CARE ASSOCIATES
- Practice address
- 1B Main Street
Wellsboro, PA 16901-1601 - Phone
- (570) 724-7100
- Fax
- (570) 724-1501
- NPI assigned
- Dec 13, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Barry A Clark, MD
- Title
- Owner
- Phone
- (570) 724-7100
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD029130E | PA | Primary |
Addresses
Primary practice location
1B Main Street
Wellsboro, PA 16901-1601
Mailing address
1B Main Street
Wellsboro, PA 16901-1601
Phone (570) 724-7100
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4623938 | Other | AETNA | |
| 006529900 | Other | PERSONAL CHOICE | |
| 34219 | Other | UPMC | |
| 2603062 | Other | GHI | |
| CX28 | Other | HEALTH ASSURANCE | |
| 794397 | Other | HEALTH CARE ADVANTAGE | |
| 0606293 | Other | PA | ACCESS CARE II |
| 070598 | Other | PA | BLUE SHIELD |
| 01032526 | Medicaid | NY | |
| 39D0980728 | Other | PA | CLEA |
| 0009089200001 | Medicaid | PA | |
| 002502 | Other | FIRST PRIORITY | |
| 050466997 | Other | NY | BLUE SHIELD |
| 13037 | Other | GHP |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1351036800000",
"number": "1437210325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1B MAIN STREET",
"city": "WELLSBORO",
"state": "PA",
"postal_code": "169011601",
"telephone_number": "570-724-7100",
"fax_number": "570-724-1501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1B MAIN STREET",
"city": "WELLSBORO",
"state": "PA",
"postal_code": "169011601",
"telephone_number": "570-724-7100",
"fax_number": "570-724-1501"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLSBORO PEDIATRIC HEALTH CARE ASSOCIATES",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-13",
"last_updated": "2012-10-24",
"status": "A",
"authorized_official_last_name": "CLARK",
"authorized_official_first_name": "BARRY",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "570-724-7100",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "PA",
"license": "MD029130E",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4623938",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONAL CHOICE",
"identifier": "006529900",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UPMC",
"identifier": "34219",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "2603062",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ASSURANCE",
"identifier": "CX28",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH CARE ADVANTAGE",
"identifier": "794397",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACCESS CARE II",
"identifier": "0606293",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "070598",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01032526",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLEA",
"identifier": "39D0980728",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0009089200001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST PRIORITY",
"identifier": "002502",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "050466997",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "13037",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Wellsboro, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.