Active NPI
Paul M Clark, M.D.
- Vascular Surgery Physician
- Toledo, OH
National Provider Identifier
1467454827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 35.039569
- Practice address
- 2213 Cherry St
#303 Acc
Toledo, OH 43608-2603 - Phone
- (419) 251-3112
- Fax
- (419) 251-3712
- NPI assigned
- Aug 15, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 35.039569 | OH | Primary |
Addresses
Primary practice location
2213 Cherry St
#303 Acc
Toledo, OH 43608-2603
Mailing address
2213 Cherry St
303 Acc
Toledo, OH 43608-2603
Phone (419) 251-3312
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00340 | Other | OH | PARAMOUNT |
| 1539188 | Medicaid | MI | |
| 0314814 | Medicaid | OH |
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.039569 | OH | MD | Vascular Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health Physicians North Specialty Care LLC | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- Surgery Physician
- Toledo, OH
- NPI 1306468418
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192492800000",
"number": "1467454827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2213 CHERRY ST",
"address_2": "303 ACC",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436082603",
"telephone_number": "419-251-3312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2213 CHERRY ST",
"address_2": "#303 ACC",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436082603",
"telephone_number": "419-251-3112",
"fax_number": "419-251-3712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "PAUL",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-15",
"last_updated": "2007-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "OH",
"license": "35.039569",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARAMOUNT",
"identifier": "00340",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1539188",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0314814",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.