Active NPI
Mark P Clemons, MD
- Otolaryngology Physician
- Memphis, TN
National Provider Identifier
1457394611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- N7584
- Practice address
- 6616 Kirby Center Cove
Memphis, TN 38115 - Phone
- (901) 363-8400
- Fax
- (901) 363-8644
- NPI assigned
- Jun 14, 2006
- Last updated
- Oct 1, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | MD0000016200 | TN | |
| Otolaryngology Physician | 207Y00000X | N7584 | AR | Primary |
Addresses
Primary practice location
6616 Kirby Center Cove
Memphis, TN 38115
Mailing address
6616 Kirby Center CV
Memphis, TN 38115
Phone (901) 363-8400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3013157 | Medicaid | TN | |
| 111549001 | Medicaid | AR |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000016200 | TN | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Ear Nose & Throat Care of the Mid-South, PLLC | Otolaryngology | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Otolaryngology Physician
- Memphis, TN
- NPI 1669725297
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349049600000",
"number": "1457394611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6616 KIRBY CENTER CV",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "38115",
"telephone_number": "901-363-8400",
"fax_number": "901-363-8644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6616 KIRBY CENTER COVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "38115",
"telephone_number": "901-363-8400",
"fax_number": "901-363-8644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMONS",
"first_name": "MARK",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2012-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "TN",
"license": "MD0000016200",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "AR",
"license": "N7584",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3013157",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "111549001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.