Clark D Phelps III, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

LL82868 Issued in SC

Practice address

701 Grove Rd FL 3
Greenville, SC 29605-4295

Phone

(864) 455-1435

Fax

(864) 455-1320

NPI assigned

Jun 18, 2019

Sex

Male

Sole proprietor

Yes

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 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

Specialty

Diagnostic Radiology

Education

Wayne State University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pelican II LLCGroup PAC ID 1759484082, 18 clinicians

Charleston Radiologists PAGroup PAC ID 9436054715, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trident Medical Center Hospital, Charleston, SC, CCN 420079
• Colleton Medical Center Hospital, Walterboro, SC, CCN 420030
• Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065

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 and National Provider Directory roles.

• Charleston Radiologists PA

  • Diagnostic Radiology Physician
  • Mount Pleasant, SC
  • NPI 1811000177
  Medicare reassignment Care Compare group NPD
• Pelican II, LLC

  • Diagnostic Radiology Physician
  • Mount Pleasant, SC
  • NPI 1871681445
  Medicare reassignment Care Compare group NPD

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

• Bon Secours St. Francis Xavier Hospital Inc.

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1851361778
  Care Compare affiliation
• Trident Medical Center, LLC

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1366496937
  Care Compare affiliation
• Walterboro Community Hospital, Inc.

  • General Acute Care Hospital
  • Walterboro, SC
  • NPI 1376597997
  Care Compare affiliation

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1730749151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 GROVE RD FL 3",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054295",
            "telephone_number": "864-455-1435",
            "fax_number": "864-455-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD FL 3",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054295",
            "telephone_number": "864-455-1435",
            "fax_number": "864-455-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "CLARK",
        "middle_name": "D",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-18",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "LL82868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam E Pflugrath, MD
• Amanda H Pham, DO
• Huong T. Pham, D.M.D.
• Vivian N Pham, MD
• Pharmacum Medical Center
• Sarah Carson Phelps, PHARMACIST
• Tori Alexandra Phelps
• Rebecca Phifer-Ball
• Phillip D. Gould, DMD, LLC
• Marva Vanessa Phillips-Williams, MD

• Surgery Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; 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.