Jev Clark

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D10561 Issued in OR

Practice address

2266 Mission St SE
Salem, OR 97302-1267

Phone

(503) 375-2000

NPI assigned

Jun 1, 2012

Last updated

Oct 18, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jev a. Clark, DMD, MD, LLC

  dba Clark Implant & Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Salem, OR
  • NPI 1831686468
  NPD Authorized official
• Windber Hospital, Inc.

  dba Windber Medical Center

  • General Acute Care Hospital
  • Windber, PA
  • NPI 1275620536
  NPD (past)

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

{
    "created_epoch": "1338508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1558622936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2266 MISSION ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973021267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2266 MISSION ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973021267",
            "telephone_number": "503-375-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2125 NW Professional Dr",
            "address_purpose": "LOCATION",
            "city": "Corvallis",
            "state": "OR",
            "postal_code": "973303886",
            "country_code": "US",
            "telephone_number": "541-757-1566",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1040 24th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "OR",
            "postal_code": "973217539",
            "country_code": "US",
            "telephone_number": "541-924-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JEV",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-01",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D10561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Clanton, RDH, EPDH
• Ann Elizabeth Clark-Delogu
• Alisha Sue Clark
• Danica E Clark, MD
• Ellis Richard Clark, MD
• Jim R Clark
• Lennon Lonnie Clark, CPM
• Zachary E Clark
• Amanda Marie Clarke
• Christine S. Clarke, MD

• Oral and Maxillofacial Surgery (Dentist) in Salem, OR
• Providers in Salem, OR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; 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.