Hollis J Clark, MD
Individual provider Active NPI Internal Medicine Physician · Murray, KY
NPI 1790766178 · NPPES record last updated Oct 16, 2015
Key facts
- NPI
- 1790766178
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 25837 (KY)
- Practice address
- 1000 S 12TH St
Murray, KY 42071-9303 - Phone
- (270) 759-9200
- Fax
- (270) 759-9966
- NPI assigned
- Nov 11, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- University of Tennessee, HSC, College of Medicine, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- VMD Primary Providers Central Kentucky
Practice addresses (Care Compare)
1000 S 12TH St
Murray, KY 42071-9303
Phone (270) 854-1444
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090328000007 | KY | Practitioner - Internal Medicine | 4880783877 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25837 | KY | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| VMD Primary Providers Central Kentucky | Internal Medicine | Current |
Accepting new patients |
| VMD Primary Providers Central Kentucky | Internal Medicine | Current |
Accepting new patients |
Locations
1000 S 12th St
Murray, KY 42071
Phone (270) 759-9200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 25837 | KY | Yes |
Addresses
Primary practice location
1000 S 12TH St
Murray, KY 42071-9303
Mailing address
1000 S 12TH St
Murray, KY 42071-9303
Phone (270) 759-9200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000050308 | Other | KY | ANTHEM PROVIDER NUMBER |
| 080025697 | Other | KY | RAILROAD MC PROVIDER NUM |
| 64258379 | Medicaid | KY |
Other providers in Murray, KY
- Jessica A Champion
- Raymond J Charette
- Charles D. Tucker, M.D., PSC
- Mary Elisabeth Chase
- Ryan Wesley Chasseur
- Nathan Blaine Clark
- Tia A Clark
- Jacob Clevenger
- Aliya Grace Clough
- Chadwick Hunter Cochran
All providers in Murray, KY · Internal Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.