Individual provider Active NPI

Carlton Keith Clarke II, MD

  • Obstetrics & Gynecology Physician
  • Garland, TX
National Provider Identifier
1467452649
Registry record updated Feb 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
L4890 Issued in TX
Practice address
407 W I 30
Garland, TX 75043-5912
Phone
(972) 303-2222
Fax
(972) 303-2220
NPI assigned
Jul 28, 2005
Last updated
Feb 1, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2016

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L4890 TX
Addiction Medicine (Family Medicine) Physician 207QA0401X L4890 TX
Adult Medicine Physician 207QA0505X L4890 TX
Geriatric Medicine (Family Medicine) Physician 207QG0300X L4890 TX
Internal Medicine Physician 207R00000X L4890 TX
Obstetrics & Gynecology Physician 207V00000X L4890 TX Primary
General Practice Physician 208D00000X L4890 TX

Addresses

Primary practice location

407 W I 30
Garland, TX 75043-5912

Mailing address

407 W Interstate 30
Garland, TX 75043-5912
Phone (972) 303-2222

Other identifiers 1

IdentifierTypeStateIssuer
1529026-01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20031114000452 TX Practitioner - Obstetrics/Gynecology 3779497649

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
L4890TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trostel OBGYN & Associates PA 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.

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454284800000",
    "number": "1467452649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 W INTERSTATE 30",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750435912",
            "telephone_number": "972-303-2222",
            "fax_number": "972-303-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 W I 30",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750435912",
            "telephone_number": "972-303-2222",
            "fax_number": "972-303-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "CARLTON",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2016-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L4890",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "TX",
            "license": "L4890",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": "L4890",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "L4890",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L4890",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "L4890",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "L4890",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1529026-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garland, TX

Sources for this page

Verify at the official NPI Registry.