Active NPI
Ben Clark Jr., DPM
- Podiatrist
- Dallas, TX
National Provider Identifier
1629099353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 400
- Practice address
- 2826 E Illinois Ave
Dallas, TX 75216 - Phone
- (214) 372-4621
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 400 | TX | Primary |
Addresses
Primary practice location
2826 E Illinois Ave
Dallas, TX 75216
Mailing address
2826 E Illinois Ave
Dallas, TX 75216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100729000184 | TX | Practitioner - Podiatry | 6901860147 | Practice locations: Dallas, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Podiatry
- Education
- Kent State University College of Podiatric Medicine, 1970
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2826 E Illinois Ave
Dallas, TX 75216-3422
Phone (214) 372-4621
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Removal of tissue | 270 |
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 596 |
| Removal or shaving of skin growth | 224 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 400 | TX | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629099353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2826 E ILLINOIS AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "75216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2826 E ILLINOIS AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "75216",
"telephone_number": "214-372-4621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BEN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "TX",
"license": "400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.