Christopher Kevin Clancy, D.M.D

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

20205 Issued in MA

Practice address

299 Lincoln St
Suite 204
Worcester, MA 01605-3609

Phone

(508) 852-0021

Fax

(508) 852-0031

NPI assigned

Nov 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 6, 2019 through Nov 6, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Worcester Oral Surgery, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Worcester, MA
  • NPI 1053470740
  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659442325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 LINCOLN ST",
            "address_2": "SUITE 204",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053609",
            "telephone_number": "508-329-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 LINCOLN ST",
            "address_2": "SUITE 204",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053609",
            "telephone_number": "508-852-0021",
            "fax_number": "508-852-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLANCY",
        "first_name": "CHRISTOPHER",
        "middle_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "20205",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN16305",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS035268",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City Home Care, LLC
• City of Worcester
• City of Worcester
• Claim Path Massachusetts, LLC
• Amanda Jane-Bean Clancey, NP
• Lyn A Clarito, PHARMD
• Terese Keating Clark-Sjogren
• Abigail Clark
• Ann Marie Clark, PA-C
• Annie H Clark, NP

• Oral and Maxillofacial Surgery (Dentist) in Worcester, MA
• Providers in Worcester, MA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Massachusetts

• 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.