J.Douglas Clark, MD PC

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

19596 Issued in SC

Legal business name

J.DOUGLAS CLARK, MD PC

Practice address

2030 North Church Place
Spartanburg, SC 29303-2796

Phone

(864) 582-6858

Fax

(864) 585-0999

NPI assigned

Feb 7, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Darla M Brown, RRT

Title

Office Manager

Phone

(864) 582-6858

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Douglas Clark, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Spartanburg, SC
  • NPI 1194798595
  Medicare reassignment NPD
• Charles M Fogarty, MD

  • Pulmonary Disease Physician
  • Spartanburg, SC
  • NPI 1316919194
  NPD (past)
• Rico V I Mendoza, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Spartanburg, SC
  • NPI 1861466021
  NPD (past)
• Wilson P Smith Jr., MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Spartanburg, SC
  • NPI 1982675625
  NPD (past)

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339372800000",
    "number": "1730229808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4276",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293054276",
            "telephone_number": "864-582-6858",
            "fax_number": "864-585-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 NORTH CHURCH PLACE",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293032796",
            "telephone_number": "864-582-6858",
            "fax_number": "864-585-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J.DOUGLAS CLARK, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2012-06-11",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DARLA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "864-582-6858",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RRT"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "19596",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "SC",
            "license": "19596",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "SC",
            "license": "19596",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "SC",
            "license": "19596",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "290009501",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MBPG'S",
            "identifier": "8688",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T3660",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori Ann Ivey, LPC
• Robin Glenn Ivey Jr., DC
• J Hill 001, LLC
• J. Todd Brown DMD
• J.a. McNeill & Sons & Daughter III, LLC (McNeill's Long Term Care Pharmacy #3)
• Brooke Jaakola
• Daniel P Jablonski, CRNA
• Tyler A Jack, D.C.
• Jackie Drummond Counseling LLC
• Melanie Lorraine Jacks, CCC-SLP

• Critical Care Medicine (Internal Medicine) Physician in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Critical Care Medicine (Internal Medicine) Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.