NPIMap

Individual provider Active NPI

William Gilmer Clark, MD

  • Family Medicine Physician
  • Wake Forest, NC
National Provider Identifier
1528047503
Registry record updated Oct 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
24323 Issued in NC
Practice address
2115 S Main St
Wake Forest, NC 27587-5011
Phone
(919) 570-2000
Fax
(919) 570-2001
NPI assigned
Jan 10, 2006
Last updated
Oct 25, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 24323 NC Primary

Addresses

Primary practice location

2115 S Main St
Wake Forest, NC 27587-5011

Mailing address

12418 Dunard St
Raleigh, NC 27614-6959
Phone (919) 554-8868

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wclark414938@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20131220000981 NC Practitioner - Family Practice 2365679214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Carolina at Chapel Hill School of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

10500 Ligon Mill Rd
Suite 113
Wake Forest, NC 27587-4576
Phone (919) 570-5705

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24323NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Family Medicine CurrentSince Dec 15, 2016 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 15, 2016 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

445 S Kings Dr
Charlotte, NC 28204
Phone (704) 384-1734

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

10500 Ligon Mill Rd
Ste 113
Wake Forest, NC 27587
Phone (919) 496-1050

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: wclark414938@direct.novanthealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1528047503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12418 DUNARD ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276146959",
            "telephone_number": "919-554-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 S MAIN ST",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875011",
            "telephone_number": "919-570-2000",
            "fax_number": "919-570-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "WILLIAM",
        "middle_name": "GILMER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "24323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wclark414938@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "2115 S Main St",
            "city": "Wake Forest",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275875011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

Verify at the official NPI Registry.