Shane Chamberlain Clark, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

35121081 Issued in OH

Practice address

347 W Milltown Rd Ste B
Wooster, OH 44691-7216

Phone

(330) 345-1540

Fax

(330) 345-1541

NPI assigned

May 21, 2009

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 OH

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

Dermatology

Education

Ohio State University College of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatologists of Southwestern Ohio, LLCGroup PAC ID 7113973041, 116 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wooster Community Hospital Hospital, Wooster, OH, CCN 360036
• Cleveland Clinic Hospital, Cleveland, OH, CCN 360180
• Salem Regional Medical Center Hospital, Salem, OH, CCN 360185

Merit-based Incentive Payment System (MIPS)

Final score

99.15 of 100Reported as group

Promoting interoperability

99

Improvement activities

40

Procedures performed for Medicare patients

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.

• Dermatologists of Southwestern Ohio, LLC.

  • Dermatology Physician
  • Dayton, OH
  • NPI 1801819883
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• City of Wooster

  • General Acute Care Hospital
  • Wooster, OH
  • NPI 1437156247
  Care Compare affiliation
• Salem Community Hospital

  • General Acute Care Hospital
  • Salem, OH
  • NPI 1639131535
  Care Compare affiliation
• Salem Community Hospital

  • Radiology Clinic/Center
  • Calcutta, OH
  • NPI 1750227377

  Hospital

  Care Compare affiliation
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Care Compare affiliation

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

{
    "created_epoch": "1242864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1548495336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "347 W MILLTOWN RD STE B",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446917216",
            "telephone_number": "330-345-1540",
            "fax_number": "330-345-1541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "347 W MILLTOWN RD STE B",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446917216",
            "telephone_number": "330-345-1540",
            "fax_number": "330-345-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANE",
        "middle_name": "CHAMBERLAIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-21",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "35121081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah D Clardy
• Shannon Bess Clark-McCleary
• Allison Victoria Rose Clark
• Ashton Lee Clark, LSW
• Claudia E. Clark
• Sireesha Achanti Clark, M.D.
• Windy Lynn Clark
• Clarkson Optometry Midwest Inc
• John W Clay
• Rebecca D. Clay, BA, CT

• Dermatology Physician in Wooster, OH
• Providers in Wooster, OH by specialty
• Dermatology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.