Clark Kennard Brackney, DPM
Individual provider Active NPI Primary Podiatric Medicine Podiatrist · Greensboro, NC
NPI 1699237016 · NPPES record last updated Aug 9, 2022
Key facts
- NPI
- 1699237016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Podiatric Medicine Podiatrist 213EP1101X
- License
- 788 (NC)
- Practice address
- 530 N Elam Ave Ste a
Greensboro, NC 27403-1139 - Phone
- (336) 299-0271
- NPI assigned
- Apr 3, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 22
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Instride Foot and Ankle Specialists, PLLC
Practice addresses (Care Compare)
102 Village Lake Rd
Siler City, NC 27344-1821
Phone (336) 443-9190
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 21 |
| Removal of skin lesions | 20 |
| Removal of nail tissue | 134 |
| Removal or shaving of skin growth | 46 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220811002746 | NC | Practitioner - Podiatry | 7517296619 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 788 | NC | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Instride Foot and Ankle Specialists, PLLC | Primary Podiatric Medicine | Current |
Accepting new patients |
| Instride Foot and Ankle Specialists, PLLC | Primary Podiatric Medicine | Current |
Accepting new patients |
Locations
1504 E Franklin St
Ste 203
Chapel Hill, NC 27514
Phone (919) 829-0076
1022 Lee Ann Dr NE
Concord, NC 28025
Phone (704) 786-4482
130 Lake Concord Rd NE
Ste B
Concord, NC 28025
Phone (704) 786-4482
1036 Branchview Dr
Ste 216
Concord, NC 28025
Phone (704) 886-1918
609 Attain St
Ste 131
Fuquay Varina, NC 27526
Phone (919) 342-6674
530 N Elam Ave
Greensboro, NC 27403
Phone (336) 299-0271
530 N Elam Ave
Ste A
Greensboro, NC 27403
Phone (336) 299-0271
1514 Glenwood Ave
Raleigh, NC 27608
Phone (919) 619-7310
102 Village Lake Rd
Siler City, NC 27344
Phone (336) 443-9190
Interoperability endpoints
- clark.brackney@ifasp.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 788 | NC | |
| Foot Surgery Podiatrist | 213ES0131X | 788 | NC | |
| Primary Podiatric Medicine Podiatrist | 213EP1101X | 788 | NC | Yes |
Addresses
Primary practice location
530 N Elam Ave Ste a
Greensboro, NC 27403-1139
Mailing address
530 N Elam Ave Ste a
Greensboro, NC 27403-1139
Phone (336) 299-0271
Other providers in Greensboro, NC
- Kennitrish Nickola Bracey
- Thomas Andrew Brackbill
- Alisha Nicole Bracken
- Angela Chyrisse Kaiulani Bracken
- Lisa Eileen Bracken
- Lindsey Braddock
- Allyson Bradley
- Cristin Leanne Bradley
- Ellen Bradley
- Linda Bradley
All providers in Greensboro, NC · Primary Podiatric Medicine Podiatrist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2022. 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.