Justin Clark, D.O.

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

OS9224 Issued in FL

Practice address

362 Beal Pkwy NW Ste 105
Fort Walton Beach, FL 32548-3926

Phone

(850) 862-3020

Fax

(850) 862-1363

NPI assigned

Mar 27, 2006

Last updated

Mar 17, 2018By the provider in NPPES

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

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

Specialty

Allergy/ImmunologyAlso: Internal Medicine

Education

R Franklin University of Med & Sci/Chicago Medical School, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

All Seasons Allergy and Asthma Center, P.a.Group PAC ID 2264465376, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DFIIBA/Endpoint/DFIIBA

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.

• All Seasons Allergy and Asthma Center, P.a.

  • Allergy & Immunology Physician
  • Fort Walton Beach, FL
  • NPI 1578618104
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1538129085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 BEAL PKWY NW STE 105",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325483926",
            "telephone_number": "850-862-3020",
            "fax_number": "850-862-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 BEAL PKWY NW STE 105",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325483926",
            "telephone_number": "850-862-3020",
            "fax_number": "850-862-1363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 Beech Avenue",
            "address_purpose": "LOCATION",
            "city": "Crestview",
            "state": "FL",
            "postal_code": "32536",
            "country_code": "US",
            "telephone_number": "850-862-3020",
            "fax_number": "850-862-1363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JUSTIN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "FL",
            "license": "OS9224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Bria Chumley, PTA
• Thomas Carton Church, M.D.
• Charles Joseph Clancy, PA-C
• Nancy Danielle Clancy
• Emily Clark, DPT
• Rhonda D Clark, CRNA
• Tony D Clark, D.M.D.
• Justyne N Clarke
• Nylah Faye Marie Clarke
• Erica Clarkson

• Allergy & Immunology Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Allergy & Immunology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.