William Robert Clark, MD
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Wpafb, OH
NPI 1649665019 · NPPES record last updated May 11, 2026
Key facts
- NPI
- 1649665019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- 35.132272 (OH)
- Practice address
- 4881 Sugar Maple Dr
Wpafb, OH 45433-5529 - Phone
- (937) 257-6877
- NPI assigned
- Apr 2, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- University of Cincinnati College of Medicine, 2015
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
8632 Glenrose LN
Cincinnati, OH 45244-2631
PO Box
Cleeveland, OH 44193
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260403001888 | OH | Practitioner - Psychiatry | 8022322718 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.132272 | OH | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dayton Children'S Hospital | Psychiatry | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 35.132272 | OH | Yes |
| Psychiatry Physician | 2084P0800X | 35.132272 | OH |
Addresses
Primary practice location
4881 Sugar Maple Dr
Wpafb, OH 45433-5529
Mailing address
4881 Sugar Maple Dr
Wpafb, OH 45433-5529
Phone (937) 257-6877
Other practice location 1
860 Valley St
Dayton, OH 45404-2066
Phone (937) 641-3060
Other practice location 2
3300 W Tech Blvd
Miamisburg, OH 45342-4865
Phone (937) 641-4040
Other practice location 3
1 Childrens Plz
Dayton, OH 45404-1815
Phone (937) 641-4040
Other providers in Wpafb, OH
- Gregory D. Carbonella
- A. Noelle Carpenter
- Kerri Beth Chamberlin
- Donna Sue Childress
- Jacqueline Marie Clark Ruhf
- Arthur William Clarkson III
- Joseph Connolly III
- Kyle V Conway
- William Carlyle Copley Jr.
- Jason M Corless
All providers in Wpafb, OH · Child & Adolescent Psychiatry Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.