NPIMap

Organization Active NPI

Paul R Clark

  • Customized Equipment (DME)
  • Allston, MA
National Provider Identifier
1851577795
Registry record updated Oct 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
PAUL R CLARK
Doing business as
clark orthopedics co.
Practice address
1 Braintree St
Allston, MA 02134-1602
Phone
(617) 787-0504
Fax
(781) 356-2074
NPI assigned
Jan 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2010

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

Authorized official

Name
Mr. Paul R. ClarkNPI 1285714907
Title
Orthotist
Phone
(617) 787-0504

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X Primary

Addresses

Primary practice location

1 Braintree St
Allston, MA 02134-1602

Mailing address

P O Box 850164
Braintree, MA 02185
Phone (617) 787-0504

Other identifiers 5

IdentifierTypeStateIssuer
670375OtherMATUFT'S NAVIGATOR
670375OtherMATUFT'S HEALTH INSURANCE
1537369MedicaidMA
375354OtherMABLUE CROSS/BLUE SHIELD OF MASSACHUSETTS
670375OtherMATUFT'S TOTAL HEALTH PLAN

Other names 1

  • clark orthopedics co. Doing business as

National Provider Directory

National Provider Directory

Locations

1 Braintree St
Boston, MA 02134
Phone (617) 787-8700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288310400000",
    "number": "1851577795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 850164",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "02185",
            "telephone_number": "617-787-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BRAINTREE ST",
            "city": "ALLSTON",
            "state": "MA",
            "postal_code": "021341602",
            "telephone_number": "617-787-0504",
            "fax_number": "781-356-2074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL R CLARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2010-10-29",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "ORTHOTIST",
        "authorized_official_telephone_number": "617-787-0504",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFT'S NAVIGATOR",
            "identifier": "670375",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFT'S HEALTH INSURANCE",
            "identifier": "670375",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1537369",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD OF MASSACHUSETTS",
            "identifier": "375354",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFT'S TOTAL HEALTH PLAN",
            "identifier": "670375",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "clark orthopedics co.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Allston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2010; 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.