Timothy Adam Clark, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

69566 Issued in GA

Practice address

304 Shorter Ave NW
Suite 201
Rome, GA 30165-4290

Phone

(706) 509-3334

Fax

(706) 509-4272

NPI assigned

May 23, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in GA, AL, TN3 enrollments

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 3

Specialty

Emergency Medicine

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Coverage LLCGroup PAC ID 3072412592, 761 clinicians

Sycamore Lakeland LLCGroup PAC ID 2668915471, 22 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeland Community Hospital Hospital, Haleyville, AL, CCN 011311
• Lakeland Community Hospital Hospital, Haleyville, AL, CCN 010125
• Livingston Regional Hospital Hospital, Livingston, TN, CCN 440187

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Emergency Coverage, LLC

  • Family Medicine Physician
  • Newport, TN
  • NPI 1427005008

  Emergency Medicine

  Medicare reassignment Care Compare group NPD
• Sycamore Lakeland LLC

  • Emergency Medicine Physician
  • Haleyville, AL
  • NPI 1184472789
  Medicare reassignment Care Compare group NPD
• Gordon Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Calhoun, GA
  • NPI 1205290467
  Medicare reassignment NPD
• Murray Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Chatsworth, GA
  • NPI 1043783970
  Medicare reassignment NPD
• Chattanooga Emergency Medicine PLLC

  • Emergency Care Clinic/Center
  • Chattanooga, TN
  • NPI 1174739908

  GA

  Medicare reassignment NPD
• Lakeland Physicians LLC

  • Family Medicine Physician
  • Haleyville, AL
  • NPI 1851780951

  Emergency Medicine

  Medicare reassignment NPD
• NWMC Emergency Physicians LLC

  • Emergency Medicine Physician
  • Winfield, AL
  • NPI 1134708506
  Medicare reassignment NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  TN

  Medicare reassignment NPD
• Gordon Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Chatsworth, GA
  • NPI 1639621485
  NPD
• Spring Creek Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Chattanooga, TN
  • NPI 1275961799
  NPD
• Sycamore Physicians LLC

  • Emergency Medicine Physician
  • Opp, AL
  • NPI 1780372557
  NPD
• Emergency Coverage Services, PC

  • Nurse Practitioner
  • Lawrenceburg, TN
  • NPI 1053351593
  NPD (past)

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

• Lakeland Community Hospital, Inc.

  • Critical Access Hospital
  • Haleyville, AL
  • NPI 1275600967
  Care Compare affiliation
• Livingston Regional Hospital LLC

  • Rural Acute Care Hospital
  • Livingston, TN
  • NPI 1396760542
  Care Compare affiliation

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

{
    "created_epoch": "1306108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414972800000",
    "number": "1669765756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 SHORTER AVE NW",
            "address_2": "SUITE 201",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654290",
            "telephone_number": "706-509-3334",
            "fax_number": "706-509-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 SHORTER AVE NW",
            "address_2": "SUITE 201",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654290",
            "telephone_number": "706-509-3334",
            "fax_number": "706-509-4272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TIMOTHY",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-23",
        "last_updated": "2014-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "69566",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "69566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134531D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134531E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134531C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134531A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134531B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134531F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Rome
• Candice Nicole Claiborne, PHD
• Kayla Clark, LPC
• Linzee E Clark, DO
• Timothy Clark, PT
• Jada Clarke, B.S.
• Richard Clay
• Kelsey Gene Clayton, FNP-BC
• Gabriel Clements, PT
• Gina P Clevenger, C-FNP

• Emergency Medicine Physician in Rome, GA
• Providers in Rome, GA by specialty
• Emergency Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; 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.