Active NPI
Ryan Gregory Clark, D.M.D.
- Dentist
- Martinsburg, WV
National Provider Identifier
1528372133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12011515A
- Practice address
- 58 Warm Springs Ave
Martinsburg, WV 25404-3800 - Phone
- (304) 263-4999
- Fax
- (304) 163-4999
- NPI assigned
- Aug 6, 2010
- Last updated
- Feb 11, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12011515A | IN | Primary |
Addresses
Primary practice location
58 Warm Springs Ave
Martinsburg, WV 25404-3800
Mailing address
PO Box 1146
Martinsburg, WV 25402-1146
Phone (304) 263-4999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12011515A | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Syracuse Community Health Center | Current | Accepting new patients | |
| Syracuse Community Health Center, Inc. | Current | Accepting new patients | |
| Shenandoah Valley Medical System, Inc. | Past | Accepting new patients |
Locations
819 S Salina St
Syracuse, NY 13202
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Organizations & group practices 3
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.
-
- Federally Qualified Health Center (FQHC)
- Syracuse, NY
- NPI 1497796353
-
- Federally Qualified Health Center (FQHC)
- Syracuse, NY
- NPI 1184886988
-
dba Healthy Smiles Oral Health Center
- Federally Qualified Health Center (FQHC)
- Martinsburg, WV
- NPI 1295062719
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360540800000",
"number": "1528372133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1146",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254021146",
"telephone_number": "304-263-4999",
"fax_number": "304-263-0984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "58 WARM SPRINGS AVE",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254043800",
"telephone_number": "304-263-4999",
"fax_number": "304-163-4999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RYAN",
"middle_name": "GREGORY",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-06",
"last_updated": "2013-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12011515A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinsburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2013; 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.