Active NPI
Justin Philip Clack, PA
- Physician Assistant
- Athens, GA
National Provider Identifier
1750634754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 242 King Ave Ste 130
Athens, GA 30606 - Phone
- (706) 613-5880
- NPI assigned
- Oct 16, 2012
- Last updated
- Mar 29, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | 6639 | GA | |
| Orthopaedic Surgery Physician | 207X00000X | 6639 | GA | |
| Orthopaedic Trauma Physician | 207XX0801X | 6639 | GA | |
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
242 King Ave Ste 130
Athens, GA 30606
Mailing address
550 Peachtree Street
Davis Fischer Building Office 330
Atlanta, GA 30308
Other practice location 1
550 Peachtree St NE
Davis Fischer Building Office 330
Atlanta, GA 30308-2208
Phone (404) 686-7858
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1199 Prince Ave
Athens, GA 30606-2797
Phone (706) 475-7000
340 Exchange Blvd
Bethlehem, GA 30620-1759
Phone (678) 963-7171
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.62 of 100
- Quality
- 83.25
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.51 of 100
- Quality
- 80.61
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6639 | GA | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Emory Clinic Inc | Current | Accepting new patients | |
| Gwinnett Medical Group, Inc | Past | Accepting new patients |
Locations
1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525
Interoperability endpoints
- jclack36051@direct.emory.org
Organizations & group practices 4
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.
-
- Cardiovascular Disease Physician
- Athens, GA
- NPI 1184130627
-
- Internal Medicine Physician
- Atlanta, GA
- NPI 1396798229
-
- Internal Medicine Physician
- Lawrenceville, GA
- NPI 1578574661
-
- General Practice Physician
- Lawrenceville, GA
- NPI 1780747469
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Athens, GA
- NPI 1437186111
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711670400000",
"number": "1750634754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 PEACHTREE STREET",
"address_2": "DAVIS FISCHER BUILDING OFFICE 330",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "242 KING AVE STE 130",
"city": "ATHENS",
"state": "GA",
"postal_code": "30606",
"telephone_number": "706-613-5880"
}
],
"practiceLocations": [
{
"address_1": "550 Peachtree St NE",
"address_2": "Davis Fischer Building Office 330",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "303082208",
"country_code": "US",
"telephone_number": "404-686-7858",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLACK",
"first_name": "JUSTIN",
"middle_name": "PHILIP",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-16",
"last_updated": "2024-03-29",
"certification_date": "2024-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "GA",
"license": "6639",
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "GA",
"license": "6639",
"primary": false
},
{
"code": "207XX0801X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Orthopaedic Trauma",
"state": "GA",
"license": "6639",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; 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.