NPIMap

Individual provider Active NPI

Roderick Clark, MD

  • Urology Physician
  • Hershey, PA
National Provider Identifier
1538880281
Registry record updated Sep 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD478170 Issued in PA
Practice address
500 University Dr RM C4830
Hershey, PA 17033-2360
Phone
(717) 531-1132
Fax
(717) 531-4475
NPI assigned
Sep 9, 2022
Last updated
Sep 9, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD478170 PA Primary

Addresses

Primary practice location

500 University Dr RM C4830
Hershey, PA 17033-2360

Mailing address

500 University Dr RM C4830
Hershey, PA 17033-2360
Phone (717) 531-1132

Other identifiers 1

IdentifierTypeStateIssuer
CAMD-0160-2520OtherCANADIAN MEDICAL IDENTIFICATION NUMBER (MINC)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20221004002817 PA Practitioner - Urology 1951787688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Dalhousie University, Faculty of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

500 Universidy Dr
A410
Hershey, PA 17033-2360
Phone (717) 531-8848

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.36 of 100Reported as group
Quality
56.69
Promoting interoperability
100
Improvement activities
40
Cost
74.52

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Milton S Hershey Medical Center Physician Group Multi-Specialty CurrentSince Sep 6, 2022 Accepting new patients
The Milton S Hershey Medical Center Physicians Group Multi-Specialty Current Accepting new patients
The Milton S Hershey Medical Center Physicians Group Multi-Specialty CurrentSince Sep 6, 2022 Accepting new patients
The Milton S. Hershey Medical Center Physicians Group Multi-Specialty Past Accepting new patients

Locations

500 University Dr
Hershey, PA 17033
Phone (717) 531-8181

500 University Dr
#410
Hershey, PA 17033
Phone (717) 531-1159

500 University Dr
#A4
Hershey, PA 17033
Phone (717) 531-6261

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

500 University Dr
Rm C4830
Hershey, PA 17033
Phone (717) 531-1132

Organizations & group practices 4

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 9

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": "1662681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1538880281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR RM C4830",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360",
            "telephone_number": "717-531-1132",
            "fax_number": "717-531-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR RM C4830",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360",
            "telephone_number": "717-531-1132",
            "fax_number": "717-531-4475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RODERICK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-09",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "MD478170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CANADIAN MEDICAL IDENTIFICATION NUMBER (MINC)",
            "identifier": "CAMD-0160-2520",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hershey, PA

Sources for this page

Verify at the official NPI Registry.