Active NPI
Herman Clark
- Home Health Aide
- Washington, DC
National Provider Identifier
1639776628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 4269 Edson PL NE
Washington, DC 20019-8024 - Phone
- (202) 415-1205
- NPI assigned
- Oct 3, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | |||
| Home Health Aide | 374U00000X | Primary |
Addresses
Primary practice location
4269 Edson PL NE
Washington, DC 20019-8024
Mailing address
2417 Kenton PL
Temple Hills, MD 20748-6812
Phone (202) 415-1205
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604016000000",
"number": "1639776628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2417 KENTON PL",
"city": "TEMPLE HILLS",
"state": "MD",
"postal_code": "207486812",
"telephone_number": "202-415-1205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4269 EDSON PL NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200198024",
"telephone_number": "202-415-1205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "HERMAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-03",
"last_updated": "2020-10-30",
"certification_date": "2020-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": null,
"license": null,
"primary": false
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.