Craig B Clark, D.O.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

03037 Issued in IA

Practice address

1301 Penn Avenue
Suite 100
Des Moines, IA 50316-2364

Phone

(515) 263-2400

Fax

(515) 263-2540

NPI assigned

Nov 17, 2005

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Iowa Heart Center PC

  • Cardiovascular Disease Physician
  • West Des Moines, IA
  • NPI 1164410932
  NPD (past)

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344470400000",
    "number": "1780666594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PENN AVE",
            "address_2": "SUITE 100",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503162350",
            "telephone_number": "515-263-2400",
            "fax_number": "515-263-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PENN AVENUE",
            "address_2": "SUITE 100",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503162364",
            "telephone_number": "515-263-2400",
            "fax_number": "515-263-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CRAIG",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2012-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IA",
            "license": "03037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780666594",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1240796",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Des Moines Iowa
• Isaac John Clair, DDS
• Cyanna Claiser, LMSW
• Claremont'S Ramsey Village LLC
• Arcintina Marie Clark, LMSW
• Jessica Clark, RN MSN
• Jessica Clark, CADC
• Justin M Clark, DO
• Kristie Clark, MSW
• Lauren E Clark, PHARM. D.

• Cardiovascular Disease Physician in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Cardiovascular Disease Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.