Fred Elton Clark III, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME102187 Issued in FL

Practice address

4401 4TH St N
Saint Petersburg, FL 33703-4728

Phone

(727) 525-4401

Fax

(727) 525-7788

NPI assigned

Aug 18, 2008

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

Other identifiers 2

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

Family Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grace Family Home Care Home health agency, Largo, FL, CCN 109406
• St Josephs Hospital Hospital, Tampa, FL, CCN 100075
• St Anthonys Hospital Hospital, Saint Petersburg, FL, CCN 100067

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fred.clark@mhp-fl.direct.office.nextgen.com
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Medical Home PL

  • Primary Care Clinic/Center
  • Saint Petersburg, FL
  • NPI 1629485271
  Medicare reassignment NPD Authorized official
• Waters Edge Medical Clinic Tampa LLC

  • Multi-Specialty Clinic/Center
  • St Petersburg, FL
  • NPI 1265054803

  Family Medicine

  Medicare reassignment NPD
• Cargo 28 Inc

  • Multi-Specialty Clinic/Center
  • St Petersburg, FL
  • NPI 1417802695
  Medicare reassignment
• Bayfront Enterprises Inc

  • Urgent Care Clinic/Center
  • St Petersburg, FL
  • NPI 1710963236
  NPD (past)

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

• Peace, Inc

  • Home Health Agency
  • Largo, FL
  • NPI 1780820910
  Care Compare affiliation
• St. Anthonys Hospital, Inc.

  • General Acute Care Hospital
  • St Petersburg, FL
  • NPI 1427024942
  Care Compare affiliation
• St. Joseph'S Hospital, Inc.

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1346519816
  Care Compare affiliation
• St. Joseph'S Hospital, Inc.

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1881632818
  Care Compare affiliation

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492473600000",
    "number": "1609022086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 4TH ST N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337034728",
            "telephone_number": "727-525-4401",
            "fax_number": "727-525-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 4TH ST N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337034728",
            "telephone_number": "727-525-4401",
            "fax_number": "727-525-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "FRED",
        "middle_name": "ELTON",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-18",
        "last_updated": "2017-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME102187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "7A6EU",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clark Chiropractic Health Center Inc
• Ann L Clark-Whitlock, ARNP
• Bailey N Clark, PA-C
• Bonita Joan Clark, APRN
• Colleen Clark, LMHC
• Gail E Clark, LCSW
• James Michael Clark, RPH
• Jonathan Andrew Clark, APRN
• Karen Yvette Clark, M.S.
• Kenneth John Clark Jr., DPT

• Family Medicine Physician in Saint Petersburg, FL
• Providers in Saint Petersburg, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; 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.