David Charles Clark Jr., MD

Primary specialty

Neuroradiology PhysicianTaxonomy code 2085N0700X

License

39405 Issued in NC

Practice address

1331 North Elm Street
Suite 200
Greensboro, NC 27401-6304

Phone

(336) 274-9614

Fax

(336) 482-2177

NPI assigned

Oct 31, 2005

Last updated

Mar 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in SC

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Imrad of Virginia PLLC

  • Diagnostic Radiology Physician
  • Woodbridge, VA
  • NPI 1457816522

  SC

  Medicare reassignment
• Pinnacle Health Services of North Carolina LLC

  dba Cardinal Points Imaging of the Carolinas, Midtown

  • Radiology Clinic/Center
  • Raleigh, NC
  • NPI 1457300089

  Diagnostic Radiology

  NPD
• Pinnacle Health Services of North Carolina, LLC

  dba Cardinal Points Imaging of the Carolinas, Clayton

  • Radiology Clinic/Center
  • Clayton, NC
  • NPI 1548454127

  Diagnostic Radiology

  NPD

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1720079767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63112",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282633112",
            "telephone_number": "336-274-9617",
            "fax_number": "336-482-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 NORTH ELM STREET",
            "address_2": "SUITE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274016304",
            "telephone_number": "336-274-9614",
            "fax_number": "336-482-2177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAVID",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NC",
            "license": "39405",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "39405",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1600796",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "70507",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA MEDICAID",
            "identifier": "1720079767",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "18290",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "22555",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8922555",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300050409",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer R Clark-Bruning, PAC
• Alan R Clark, PA-C
• Ashley Clark, ITFS
• Cheryl Clark, FNP
• Christopher Jerome Clark, M.D.
• Dyanna Geffel Clark, M.D.
• Gilbert W Clark, PA-C
• Holly Ann Clark, CADC
• Jaylah Clark
• Jerry R Clark, DDS, MS

• Neuroradiology Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Neuroradiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.