NPIMap

Individual provider Active NPI

Clark Stallings, MD

  • Internal Medicine Physician
  • Nottingham, MD
National Provider Identifier
1477176303
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0096610 Issued in MD
Practice address
4924 Campbell Blvd Ste 200
Nottingham, MD 21236-5914
Phone
(443) 442-2300
NPI assigned
May 27, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D96610 MD
Student in an Organized Health Care Education/Training Program 390200000X MT220667 PA
Internal Medicine Physician 207R00000X D0096610 MD Primary

Addresses

Primary practice location

4924 Campbell Blvd Ste 200
Nottingham, MD 21236-5914

Mailing address

4924 Campbell Blvd Ste 200
Baltimore, MD 21236-5914
Phone (443) 442-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230726002879 MD Practitioner - Internal Medicine 6901227669 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Vanderbilt University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians

Practice addresses (Care Compare)

1000 E Eager St
E Baltimore Med Ctr
Baltimore, MD 21202-5533
Phone (410) 522-9800

12 Newport Dr
Suite a
Forest Hill, MD 21050-1758

4924 Campbell Blvd
Suite 200
Baltimore, MD 21236-5914
Phone (443) 442-2300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0096610MDMDInternal Medicine Physician
D96610MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins Community Physicians Internal Medicine CurrentSince Jul 1, 2023 Accepting new patients
Johns Hopkins Community Physicians, Inc Internal Medicine Current Accepting new patients
Johns Hopkins Community Physicians Internal Medicine CurrentSince Jul 1, 2023 Accepting new patients

Locations

1000 E Eager St
Baltimore, MD 21202
Phone (410) 522-9800

6201 Greenleigh Ave
Middle River, MD 21220
Phone (410) 933-2704

4924 Campbell Blvd
Ste 200
Nottingham, MD 21236
Phone (443) 442-2300

Interoperability endpoints

  • Direct secure messaging: cstallings1124585@direct.hopkinsmedicine.org

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1477176303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4924 CAMPBELL BLVD STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212365914",
            "telephone_number": "443-442-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4924 CAMPBELL BLVD STE 200",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212365914",
            "telephone_number": "443-442-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLINGS",
        "first_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-27",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D96610",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT220667",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0096610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nottingham, MD

Sources for this page

Verify at the official NPI Registry.