Clark B Wysong, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25168 Issued in AZ

Practice address

19875 N 51St Ave
Glendale, AZ 85308-5114

Phone

(623) 581-8998

Fax

(623) 581-6461

NPI assigned

Mar 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

University of Oklahoma College of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sonoran Medical CentersGroup PAC ID 0648260364, 12 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: clark.wysongmd.p1@direct.sonoranmed.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sonoran Medical Centers

  • Family Medicine Physician
  • Glendale, AZ
  • NPI 1417053885
  Medicare reassignment Care Compare group NPD
• Lankford Holdings Monogram, Inc

  • Non-Pharmacy Dispensing Site
  • Glendale, AZ
  • NPI 1134561939
  NPD (past)
• No Appointment MD

  • Medical Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1942429923
  NPD (past)

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

{
    "created_epoch": "1141603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357776000000",
    "number": "1861469165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19875 N 51ST AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085114",
            "telephone_number": "623-581-8998",
            "fax_number": "623-581-6461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19875 N 51ST AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085114",
            "telephone_number": "623-581-8998",
            "fax_number": "623-581-6461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYSONG",
        "first_name": "CLARK",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-06",
        "last_updated": "2013-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "25168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "385527",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Maria Wu
• Wura Cares LLC
• Lori Wyke
• Gale W. Wyman, ED.D.
• Wynn Dental Corporation
• Ana Josceline Xum
• Yabis LLC
• Cheryl Yamamoto, PA-C
• Patricia L. Yamamoto, LISAC
• Jennifer Yancey, M.S. SLP CF

• Family Medicine Physician in Glendale, AZ
• Providers in Glendale, 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 Jan 10, 2013; 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.