Tanner Cody Clark, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

24268 Issued in NH

Practice address

703 Riverway Place
Bedford, NH 03110, NH 03110

Phone

(603) 627-1661

Fax

(603) 669-6944

NPI assigned

Apr 11, 2015

Last updated

Sep 8, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in HI, NH2 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 2

Specialty

Diagnostic Radiology

Education

University of Washington School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern New Hampshire Radiology Consultants PCGroup PAC ID 2769436088, 39 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elliot Hospital Hospital, Manchester, NH, CCN 300012
• Southern NH Medical Center Hospital, Nashua, NH, CCN 300020
• Catholic Medical Center Hospital, Manchester, NH, CCN 300034
• Androscoggin Valley Hospital Hospital, Berlin, NH, CCN 301310
• Speare Memorial Hospital Hospital, Plymouth, NH, CCN 301311

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Southern New Hampshire Radiology Consultants PC

  • Diagnostic Radiology Physician
  • Bedford, NH
  • NPI 1780648915

  HI

  Medicare reassignment Care Compare group NPD
• Diagnostic Radiologists PC

  • Diagnostic Radiology Physician
  • Portland, OR
  • NPI 1053368563

  HI

  Medicare reassignment

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

• Southern NH Medical Center

  • General Acute Care Hospital
  • Nashua, NH
  • NPI 1245447994
  Care Compare affiliation Name & address match
• Androscoggin Valley Hospital Inc

  dba AVH Surgical Associates

  • General Practice Physician
  • Berlin, NH
  • NPI 1679526644

  Hospital

  Care Compare affiliation
• Androscoggin Valley Hospital, Inc.

  • Critical Access Hospital
  • Berlin, NH
  • NPI 1386680593
  Care Compare affiliation
• Elliot Hospital of the City of Manchester

  • General Acute Care Hospital
  • Manchester, NH
  • NPI 1902996028
  Care Compare affiliation
• Manchester Health Services, LLC

  dba Catholic Medical Center

  • General Acute Care Hospital
  • Manchester, NH
  • NPI 1972340990
  Care Compare affiliation
• Speare Memorial Hospital

  • Specialist
  • Plymouth, NH
  • NPI 1023036191

  Hospital

  Care Compare affiliation
• Speare Memorial Hospital

  dba Speare Podiatry

  • Foot & Ankle Surgery Podiatrist
  • Plymouth, NH
  • NPI 1407690019

  Hospital

  Care Compare affiliation
• Speare Memorial Hospital

  • Critical Access Hospital
  • Plymouth, NH
  • NPI 1760496376
  Care Compare affiliation
• Speare Memorial Hospital

  dba Wound Care & Hyperbaric Medicine Center

  • Wound Care Registered Nurse
  • Plymouth, NH
  • NPI 1861823999

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1428710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1689060139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 RIVERWAY PLACE",
            "city": "BEDFORD, NH 03110",
            "state": "NH",
            "postal_code": "03110",
            "telephone_number": "603-627-1661",
            "fax_number": "603-669-6944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 RIVERWAY PLACE",
            "city": "BEDFORD, NH 03110",
            "state": "NH",
            "postal_code": "03110",
            "telephone_number": "603-627-1661",
            "fax_number": "603-669-6944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TANNER",
        "middle_name": "CODY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-11",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD60961230",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NH",
            "license": "24268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.