Active NPI
Ian Clarke, LPN
- Licensed Practical Nurse
- New Haven, CT
National Provider Identifier
1669778908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 035458
- Practice address
- 400 Columbus Ave
New Haven, CT 06519-1233 - Phone
- (203) 503-3000
- NPI assigned
- Feb 3, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 035458 | CT | Primary |
Addresses
Primary practice location
400 Columbus Ave
New Haven, CT 06519-1233
Mailing address
400 Columbus Ave
New Haven, CT 06519-1233
Phone (203) 503-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004235900 | Medicaid | CT |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035458 | CT | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296691200000",
"number": "1669778908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 COLUMBUS AVE",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065191233",
"telephone_number": "203-503-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 COLUMBUS AVE",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065191233",
"telephone_number": "203-503-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "IAN",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-02-03",
"last_updated": "2011-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "CT",
"license": "035458",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004235900",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.