Clark Dale Gaddy, M.D

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

ME0048155 Issued in FL

Practice address

1179 NW 64TH Ter
Gainesville, FL 32605-4218

Phone

(352) 333-5400

Fax

(352) 333-5404

NPI assigned

Jul 10, 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 FL

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

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.

• Simedhealth LLC

  • Internal Medicine Physician
  • Gainesville, FL
  • NPI 1639680127
  Medicare reassignment NPD
• Simed Health LLC

  • Community/Retail Pharmacy
  • Gainesville, FL
  • NPI 1376616698
  NPD

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260316800000",
    "number": "1528092061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 NW 8TH AVE",
            "address_2": "SUITE 2",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054582",
            "telephone_number": "352-373-6338",
            "fax_number": "352-373-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 NW 64TH TER",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054218",
            "telephone_number": "352-333-5400",
            "fax_number": "352-333-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADDY",
        "first_name": "CLARK",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2009-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME0048155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043860000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail Lomangcolob Gabriel, ARNP
• Joseph Michael Gabriel, OT
• Jessica Gabrielian
• Gabrielle Peterson, M.S. LMFT PLLC
• Joy Gabrielli, PHD
• Jaya Prakash Gadikota
• Lara Beth Gadkowski, MD MPH MS
• Gadson'S Homemaker and Companion Agency
• Suzanna Claire Gaeta, FNP-BC
• Jacob George Gaetanos, MD

• Urology Physician in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Urology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.