Active NPI
Timothy H Clark, ATC
- Athletic Trainer
- Riverside, CA
National Provider Identifier
1518413228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 8432 Magnolia Ave
Riverside, CA 92504 - Phone
- (951) 552-8512
- NPI assigned
- Sep 1, 2016
- Last updated
- Sep 1, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
8432 Magnolia Ave
Riverside, CA 92504
Mailing address
243 Montana del Lago Drive
Rancho Santa Margarita, CA 92688
Phone (714) 883-6133
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 930906 | Other | NATA MEMBER NUMBER | |
| 099302424 | Other | NATA-BOC |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1518413228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "243 MONTANA DEL LAGO DRIVE",
"city": "RANCHO SANTA MARGARITA",
"state": "CA",
"postal_code": "92688",
"telephone_number": "714-883-6133",
"fax_number": "951-689-4754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8432 MAGNOLIA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "92504",
"telephone_number": "951-552-8512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TIMOTHY",
"middle_name": "H",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-01",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATA MEMBER NUMBER",
"identifier": "930906",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATA-BOC",
"identifier": "099302424",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.