Benjamin T Clark, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

006841 Issued in AZ

Practice address

1840 S Stapley Dr Ste 101
Mesa, AZ 85204-6682

Phone

(480) 464-6979

Fax

(480) 464-6910

NPI assigned

Jun 24, 2010

Last updated

Dec 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Family Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nextcare Arizona I JV LLCGroup PAC ID 7416393194, 297 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: benjamin.clark@277236870545412.direct.elationemr.com
• Direct secure messaging: benjamin.clarkdo.p1@direct.nextcare.nextgenshare.com

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.

• Nextcare Arizona I JV LLC

  • Urgent Care Clinic/Center
  • Tempe, AZ
  • NPI 1114798071
  Medicare reassignment Care Compare group NPD
• Nextcare Arizona LLC

  dba NextCare Urgent Care

  • Urgent Care Clinic/Center
  • Tempe, AZ
  • NPI 1043371826
  Medicare reassignment NPD
• Cigna Health Care of Arizona Inc

  dba EVERNORTH Care Group Stapley Urgent Care

  • Urgent Care Clinic/Center
  • Mesa, AZ
  • NPI 1467564302
  NPD
• Cigna Health Care of Arizona Inc.

  dba CMG Clyde Wright Urgent Care, CMG Clyde Wright AHC, Phoenix Central UC

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1245338235
  NPD
• Cigna Health Care of Arizona Inc.

  dba Clyde Wright Center, CMG Phx Central MultiSpec Cntr

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1942371679
  NPD
• Cigna Healthcare of Arizona, Inc.

  dba EVERNORTH Care Group

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1073626404
  NPD
• Cigna Healthcare of Arizona, Inc.

  dba CIGNA Mesa Health Care Center, Red Mountain Medical Office

  • Multi-Specialty Clinic/Center
  • Mesa, AZ
  • NPI 1790950988
  NPD

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1831400894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25500 N NORTERRA DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850858200",
            "telephone_number": "623-277-1130",
            "fax_number": "866-837-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 S STAPLEY DR STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046682",
            "telephone_number": "480-464-6979",
            "fax_number": "480-464-6910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5891 W Eugie Ave",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853041252",
            "country_code": "US",
            "telephone_number": "602-588-6725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BENJAMIN",
        "middle_name": "T",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-24",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "006841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nakiya Claiborne
• Shelly Ann Clanton, O.D.
• Denice Darneal Clapp
• Clarity Eye Center, P.C.
• Ashlyn Clark
• Joel R. Clark, D.D.S.
• Marion Sharon Clark, COTAL
• Marlene L Clark
• Meredith Helen Clark, LPC
• Romney Clark

• Family Medicine Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.