Justin Wayne Clark, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

K4662 Issued in TX

Practice address

3601 22ND St
Lubbock Dermatology
Lubbock, TX 79410-1309

Phone

(806) 796-7193

Fax

(806) 796-0034

NPI assigned

Sep 13, 2005

Last updated

Oct 25, 2007By the provider in NPPES

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 1

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of Texas Medical Branch at Galveston, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lubbock Dermatology and Skin Cancer CenterGroup PAC ID 9032128053, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Covenant Medical Center Hospital, Lubbock, TX, CCN 450040
• Covenant Childrens Hospital Hospital, Lubbock, TX, CCN 453306

Merit-based Incentive Payment System (MIPS)

Final score

98.89 of 100Reported as group

Quality

100

Improvement activities

40

Cost

96.29

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: justin.clark@direct.myteamcare.com

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.

• Lubbock Dermatology and Skin Cancer Center

  dba Lubbock Dermatology

  • Dermatology Physician
  • Lubbock, TX
  • NPI 1295721066
  Medicare reassignment Care Compare group NPD

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

• Covenant Medical Center

  • General Acute Care Hospital
  • Lubbock, TX
  • NPI 1972517365
  Care Compare affiliation
• Methodist Children's Hospital

  dba Covenant Children's Hospital

  • Children's Hospital
  • Lubbock, TX
  • NPI 1437171568
  Care Compare affiliation

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193270400000",
    "number": "1639164098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 22ND ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101309",
            "telephone_number": "806-796-7193",
            "fax_number": "806-796-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 22ND ST",
            "address_2": "LUBBOCK DERMATOLOGY",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101309",
            "telephone_number": "806-796-7193",
            "fax_number": "806-796-0034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JUSTIN",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2007-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "K4662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120680701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Landry David Clapp, DDS
• Angelea Michele Clarida, LVN
• Alicia Clark, MDT
• Calvin Clark, RN, MSN, ACNP-BC
• Courtney Shay Clark, PTA
• Nathan R Clark, MD
• Sara B Clark, M.S., CCC-SLP
• Shawn Clark
• Claudio Caycedo DDS, PA
• Catalina Clavijo, PT

• Dermatology Physician in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.

Verify at the official NPI Registry.