Charles N Clark Jr., MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

TL24404 Issued in SC

Practice address

125 Doughty St
Suite 420
Charleston, SC 29403

Phone

(843) 723-3441

Fax

(843) 805-4040

NPI assigned

May 19, 2006

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

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

Specialty

Anesthesiology

Education

East Tennessee State University Quillen College of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesia Associates of Charleston PAGroup PAC ID 4082607361, 38 clinicians

Bon Secours St Francis Xavier Hospital IncGroup PAC ID 8325008717, 202 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Roper Hospital Hospital, Charleston, SC, CCN 420087
• Mount Pleasant Hospital Hospital, Mount Pleasant, SC, CCN 420104

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 and National Provider Directory roles.

• Anesthesia Associates of Charleston, P.a.

  • Anesthesiology Physician
  • Charleston, SC
  • NPI 1396776670
  Medicare reassignment Care Compare group NPD
• Bon Secours St Francis Xavier Hospital, Inc.

  • Cardiovascular Disease Physician
  • Charleston, SC
  • NPI 1740502822
  Medicare reassignment Care Compare group
• Bon Secours St. Francis Xavier Hospital, Inc.

  dba St. Francis Anesthesia

  • Anesthesiology Physician
  • Charleston, SC
  • NPI 1871035956
  NPD
• Anesthesia Associates of Charleston, P.a.

  • Non-Pharmacy Dispensing Site
  • Mount Pleasant, SC
  • NPI 1629693668
  NPD (past)

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

• Roper Hospital, Inc

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1962472860
  Care Compare affiliation
• Roper St. Francis Mount Pleasant Hospital

  dba Mount Pleasant Hospital

  • General Acute Care Hospital
  • Mount Pleasant, SC
  • NPI 1255645644
  Care Compare affiliation

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1528012382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22206",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294132206",
            "telephone_number": "843-723-3441",
            "fax_number": "843-805-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 DOUGHTY ST",
            "address_2": "SUITE 420",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29403",
            "telephone_number": "843-723-3441",
            "fax_number": "843-805-4040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2095 Henry Tecklenburg Dr",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294145733",
            "country_code": "US",
            "telephone_number": "843-402-1436",
            "fax_number": "843-402-1833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLES",
        "middle_name": "N",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "TL24404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "244042",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Louise Clark, RN, BSN
• Amber Mariah Clark, LPC, NCC
• Aurela Clark, M.D.
• Caitlin May Clark, OTR/L
• Carlee Clark, M.D.
• Dallas Clark, DMD
• Deanna Deloney Clark, COTA/L
• Elizabeth McInnis Clark
• Evelyn E Clark, CRNA
• Jason M Clark, MD

• Anesthesiology Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Anesthesiology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.