NPIMap

Individual provider Active NPI

John D Clark, PA-C

  • Surgical Physician Assistant
  • Damariscotta, ME
National Provider Identifier
1841228889
Registry record updated Nov 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA-319 Issued in ME
Practice address
39 Miles St.
Damariscotta, ME 04543-0000
Phone
(207) 563-1040
Fax
(207) 563-1039
NPI assigned
Jun 29, 2006
Last updated
Nov 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA-319 ME Primary

Addresses

Primary practice location

39 Miles St.
Damariscotta, ME 04543-0000

Mailing address

4 Glen Cove Dr Ste 206
Rockport, ME 04856-4239
Phone (207) 921-5454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060703000083 ME Practitioner - Physician Assistant 4587676820 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

4 Glen Cove Dr
Suite 206
Rockport, ME 04856-4239
Phone (207) 921-5454

6 Glen Cove Dr
Rockport, ME 04856-4272
Phone (207) 921-8969

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Dec 1, 2018 Accepting new patients
Mainehealth CurrentSince Dec 1, 2018 Accepting new patients
Mainehealth Past Accepting new patients
Mainehealth Past Accepting new patients

Locations

35 Miles St
Damariscotta, ME 04543
Phone (207) 563-1234

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

3 Glen Cove Dr
#3
Rockport, ME 04856
Phone (207) 301-5400

4 Glen Cove Dr
Ste 202
Rockport, ME 04856
Phone (207) 593-5800

4 Glen Cove Dr
Ste 206
Rockport, ME 04856
Phone (207) 301-5454

4 Glen Cove Dr
Ste 5
Rockport, ME 04856
Phone (207) 593-5883

Interoperability endpoints

  • Direct secure messaging: jclark13444@direct.mmc.mainehealth.org

Organizations & group practices 6

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.

Hospital & facility affiliations 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541548800000",
    "number": "1841228889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 GLEN COVE DR STE 206",
            "city": "ROCKPORT",
            "state": "ME",
            "postal_code": "048564239",
            "telephone_number": "207-921-5454",
            "fax_number": "207-921-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 MILES ST.",
            "city": "DAMARISCOTTA",
            "state": "ME",
            "postal_code": "045430000",
            "telephone_number": "207-563-1040",
            "fax_number": "207-563-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOHN",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2018-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ME",
            "license": "PA-319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Damariscotta, ME

Sources for this page

Verify at the official NPI Registry.