Praeophayom Clarke, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

25MA11029400 Issued in NJ

Practice address

30 Prospect Ave
Hackensack, NJ 07601-1915

Phone

(551) 996-2000

NPI assigned

May 2, 2017

Last updated

May 26, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ

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

Specialty

Anesthesiology

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New Jersey Healthcare Specialists PCGroup PAC ID 2668385253, 570 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hackensack University Medical Center Hospital, Hackensack, NJ, CCN 310001

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• New Jersey Healthcare Specialists PC

  • Anesthesiology Physician
  • Hackensack, NJ
  • NPI 1174585780
  Medicare reassignment Care Compare group NPD

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

• HMH Hospitals Corporation

  dba Hackensack University Medical Center

  • General Acute Care Hospital
  • Hackensack, NJ
  • NPI 1457456279
  Care Compare affiliation
• HMH Hospitals Corporation

  dba Hackensack Meridian Diagnostic Laboratory

  • Clinical Medical Laboratory
  • Hackensack, NJ
  • NPI 1518683929

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1493683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1487180055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 PROSPECT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011915",
            "telephone_number": "551-996-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 PROSPECT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011915",
            "telephone_number": "551-996-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "PRAEOPHAYOM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-02",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NJ",
            "license": "25MA11029400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Hackensack",
            "affiliation": "N",
            "address_1": "30 Prospect Ave",
            "city": "Hackensack",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "076011915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• City of Hackensack Fire Department
• Elizabeth Clanaman
• Eleanor Ann Clark II, BA, CADC
• Sharonda Nicole Clark, MD
• Nadine Clarke-Bailey
• Briana Joy Clauss, DC
• Katharine N Clouser, M.D.
• Carly Gerogia Cobbol, DO
• Melissa Cobos, APN
• Elliot Seth Coburn, MD

• Anesthesiology Physician in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Anesthesiology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.