NPIMap

Individual provider Active NPI

David Frederick Clark, MD

  • Neurology Physician
  • Overland Park, KS
National Provider Identifier
1629230479
Registry record updated Jun 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
0436405 Issued in KS
Practice address
12140 Nall Ave
Suite 230
Overland Park, KS 66209-2503
Phone
(913) 661-9448
Fax
(913) 661-4688
NPI assigned
Jul 1, 2008
Last updated
Jun 12, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 12, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OH
Neurology Physician 2084N0400X 0436405 KS Primary

Addresses

Primary practice location

12140 Nall Ave
Suite 230
Overland Park, KS 66209-2503

Mailing address

12140 Nall Ave
Suite 230
Overland Park, KS 66209-2503
Phone (913) 661-9448

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20130722000423 KS Practitioner - Neurology 8628218435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Texas Southwestern Medical School at Dallas, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Johnson County Neurology LLCGroup PAC ID 8224134226, 4 clinicians
Ability KCGroup PAC ID 0143116368, 166 clinicians

Practice addresses (Care Compare)

12140 Nall Ave
Suite 230
Leawood, KS 66209-2507
Phone (913) 661-9434

3011 Baltimore Ave
Kansas City, MO 64108-3403
Phone (816) 751-7832

5721 W 119TH St
Menorah Medical Center
Overland Park, KS 66209-3722
Phone (913) 498-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as individual
Quality
86.14
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Johnson County Neurology LLC Neurology CurrentSince Jul 22, 2013 Accepting new patients

Locations

12140 Nall Ave
Ste 230
Overland Park, KS 66209
Phone (913) 661-9434

5721 W 119th St
Shawnee Msn, KS 66209
Phone (913) 253-3000

Interoperability endpoints

  • Direct secure messaging: david.clark@hca2.eclinicaldirectplus.com

Organizations & group practices 2

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 6

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": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370995200000",
    "number": "1629230479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12140 NALL AVE",
            "address_2": "SUITE 230",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662092503",
            "telephone_number": "913-661-9448",
            "fax_number": "913-661-4688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12140 NALL AVE",
            "address_2": "SUITE 230",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662092503",
            "telephone_number": "913-661-9448",
            "fax_number": "913-661-4688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAVID",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-01",
        "last_updated": "2013-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "KS",
            "license": "0436405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.