Active NPI
Bruce M Clark, C.P.O
- Specialist
- Southfield, MI
National Provider Identifier
1437252525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 921
- Practice address
- 24395 Greenfield Rd
Southfield, MI 48075-3118 - Phone
- (248) 557-2323
- Fax
- (248) 557-3639
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 921 | Primary |
Addresses
Primary practice location
24395 Greenfield Rd
Southfield, MI 48075-3118
Mailing address
24395 Greenfield Road
Southfield, MI 48075
Phone (248) 557-2323
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05096363 | Medicaid | MI |
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Orthopedic Laboratory Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Prosthetic/Orthotic Supplier
- Southfield, MI
- NPI 1831137280
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1437252525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24395 GREENFIELD ROAD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "48075",
"telephone_number": "248-557-2323",
"fax_number": "248-557-3639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24395 GREENFIELD RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480753118",
"telephone_number": "248-557-2323",
"fax_number": "248-557-3639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BRUCE",
"middle_name": "M",
"name_prefix": "Prof.",
"credential": "C.P.O",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-06",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": "921",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05096363",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.