Derek Anthony Clark

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1235 Spring Garden St
Philadelphia, PA 19123-3206

Phone

(215) 769-3561

NPI assigned

Jan 13, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• C3 Solutions Home Healthcare PHL, LLC

  • In Home Supportive Care Agency
  • Philadelphia, PA
  • NPI 1639934581
  NPD Authorized official
• Bebashi Transition to Hope

  • Case Management Agency
  • Philadelphia, PA
  • NPI 1679282701
  NPD
• Bebashi Transition to Hope

  • Case Management Agency
  • Philadelphia, PA
  • NPI 1487935805
  NPD (past)

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

{
    "created_epoch": "1673568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1497469480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 SPRING GARDEN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191233206",
            "telephone_number": "215-769-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 SPRING GARDEN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191233206",
            "telephone_number": "215-769-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DEREK",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-13",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024869940002",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "derekc@bebashi.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1235 Spring Garden St",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191233206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amy S Clark, MD
• Casmer Kisha Clark
• Christopher Clark, NP
• Claire Alexis Clark, M.S.
• Cynthia Anne Clark, CRNP
• Fabienne A. Clark
• Irene Maria Clark, LCSW
• Jae H Clark, ATC, LAT
• Janell Lanice Clark, CRNP
• Jasmen Clark

• Case Manager/Care Coordinator in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Case Manager/Care Coordinator in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.