Edward Deallen Clark, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

K3564 Issued in TX

Practice address

1600 W College St Ste LL10
Grapevine, TX 76051-3598

Phone

(817) 410-7982

Fax

(817) 410-7986

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: edward.clark.1@23677.direct.athenahealth.com

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

• Arlington Physician Services PA

  • Obstetrics & Gynecology Physician
  • Mansfield, TX
  • NPI 1093144610
  Medicare reassignment NPD
• Longview Wellness Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1942269493

  Obstetrics & Gynecology

  Medicare reassignment NPD
• Obhg Texas Holdings, P.a.

  • Obstetrics & Gynecology Physician
  • Austin, TX
  • NPI 1083917769
  Medicare reassignment NPD
• Bkchen, PLLC

  • Obstetrics & Gynecology Physician
  • Grapevine, TX
  • NPI 1972738565
  NPD
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1255137659

  Obstetrics & Gynecology

  NPD
• Baylor Regional Medical Center at Grapevine

  • General Acute Care Hospital
  • Grapevine, TX
  • NPI 1073511762
  NPD (past)
• Columbia Medical Center of Lewisville Subsidiary LP

  • General Acute Care Hospital
  • Lewisville, TX
  • NPI 1255384533
  NPD (past)
• HCA Houston OB Hospitalist, PLLC

  • Obstetrics & Gynecology Physician
  • Corpus Christi, TX
  • NPI 1144081431
  NPD (past)
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1447910542

  Obstetrics & Gynecology

  NPD (past)
• Questcare Obstetrics PLLC

  • Obstetrics & Gynecology Physician
  • Plano, TX
  • NPI 1184897159
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730294232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W COLLEGE ST STE LL10",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513598",
            "telephone_number": "817-410-7982",
            "fax_number": "817-410-7986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W COLLEGE ST STE LL10",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513598",
            "telephone_number": "817-410-7982",
            "fax_number": "817-410-7986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "EDWARD",
        "middle_name": "DEALLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "K3564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Civitas Dra 2016 Managment LLC
• CKW Group, Advanced Venous Therapy
• Robert Michael Clague, PAC
• Allyssa Destiny Clancy, M.S, CCC-SLP
• Amanda Anne Clark, PA-C
• Clinical Anesthesia Consultants LLC
• Clinical Associates, Inc
• Clinical Pediatric Associates of Irving & Las Colinas PA
• Cloud Medical Transportation LLC
• Zekendra Clovis

• Obstetrics & Gynecology Physician in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Obstetrics & Gynecology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.