Matthew Thomas Clark, M.D.

Primary specialty

Pediatric Rheumatology PhysicianTaxonomy code 2080P0216X

License

87391 Issued in SC

Practice address

200 Patewood Dr Ste A200
Greenville, SC 29615-3580

Phone

(864) 454-5004

Fax

(864) 241-9202

NPI assigned

Apr 22, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mclark62581@direct.ghs.myhfn.org

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.

• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217

  Pediatrics

  Medicare reassignment NPD
• Shriners Hospitals for Children

  • Pediatric Orthopaedic Surgery Physician
  • Greenville, SC
  • NPI 1134566953
  Medicare reassignment NPD
• Prisma Health University Medical Group

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD
• Shriners Hospitals for Children

  • Orthopaedic Surgery Physician
  • Philadelphia, PA
  • NPI 1275271462

  Pediatrics

  NPD
• Shriners Hospitals for Children

  • Clinic/Center
  • Aiea, HI
  • NPI 1568299857
  NPD
• Vanderbilt University

  • Internal Medicine Physician
  • Nashville, TN
  • NPI 1235154972

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1467872044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR STE A200",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153580",
            "telephone_number": "864-454-5004",
            "fax_number": "864-241-9202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Childrens Way",
            "address_2": "Suite 2404",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320005",
            "country_code": "US",
            "telephone_number": "615-936-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MATTHEW",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-22",
        "last_updated": "2022-09-08",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0216X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Rheumatology",
            "state": "SC",
            "license": "87391",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "55984",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mclark20424@direct.vumc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Health Information Service Provider",
            "address_1": "2200 Childrens Way",
            "address_2": "Suite 2404",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "372320005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lynda Laura Clark, M.S.
• Mackenzie Bagwell Clark
• Madison Clark
• Martha Jameson Clark, APRN
• Mary Kathlyn Clark, FNP
• Russell Derrick Clark, DPT
• Sara Morgan Clark, M.D.
• Susan Nock Clark, RN
• Taylor Ellis Clark, FNP-C
• Thomas Monroe Clark, DDS

• Pediatric Rheumatology Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Pediatric Rheumatology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.