Candace Renee Clocker, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101261852 Issued in VA

Practice address

2100 Wilborn Ave
South Boston, VA 24592-1628

Phone

(434) 517-8022

Fax

(434) 517-8370

NPI assigned

Oct 12, 2007

Last updated

Mar 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA, NC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cclocker528347@direct.sentara.net

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.

• Albemarle Physician Services - Sentara, Inc

  • Family Medicine Physician
  • Norfolk, VA
  • NPI 1942443130

  NC, Pediatrics

  Medicare reassignment NPD
• Halifax Regional Hospital, Inc.

  dba Sentara Halifax Regional Hospital

  • General Acute Care Hospital
  • South Boston, VA
  • NPI 1588668842
  Medicare reassignment NPD
• Halifax Regional Hospital, Inc

  dba Sentara Gynecology Specialists

  • Rural Health Clinic/Center
  • South Boston, VA
  • NPI 1033728803
  NPD
• Albemarle Physician Services - Sentara, Inc

  dba Sentara Urgent Care

  • Urgent Care Clinic/Center
  • Kitty Hawk, NC
  • NPI 1306202627
  NPD

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

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1841488905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921628",
            "telephone_number": "434-517-8022",
            "fax_number": "434-517-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921628",
            "telephone_number": "434-517-8022",
            "fax_number": "434-517-8370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1141 N Road St Ste M",
            "address_purpose": "LOCATION",
            "city": "Elizabeth City",
            "state": "NC",
            "postal_code": "279093354",
            "country_code": "US",
            "telephone_number": "252-384-2590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLOCKER",
        "first_name": "CANDACE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-12",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "SC",
            "license": "33110",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2013-01833",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101261852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "33110",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ketul Chaudhary, PHARMACIST
• Arash Chehrazi, MD
• Brittany Clark, RBT
• Todd C Clarkson, DDS
• Debra G. Claycomb, D.D.S.
• CMF Transport
• Cynthia Blanks Cole, NP-C
• Sharonda Cole
• Alexis Leigh Coleman, PA
• Debra A Collins, FNP-BC

• Pediatrics Physician in South Boston, VA
• Providers in South Boston, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.