NPIMap

Individual provider Active NPI

Earl E Clark, PAC

  • Physician Assistant
  • Livingston, TX
National Provider Identifier
1861565046
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00503 Issued in TX
Practice address
1717 Highway 59 Loop N
Livingston, TX 77351-5703
Phone
(936) 329-8500
NPI assigned
Nov 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00503 TX Primary

Addresses

Primary practice location

1717 Highway 59 Loop N
Livingston, TX 77351-5703

Mailing address

111 Westchester St
Lufkin, TX 75901-7357
Phone (936) 633-0606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20040416000641 TX Practitioner - Physician Assistant 9931194222 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA00503TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
D & F Med, PLLC CurrentSince Mar 13, 2018 Accepting new patients
Texas Emergency Room Services PA Past Accepting new patients
Angelina County & Cities Health District PastSince Feb 1, 2000 Accepting new patients
Camino Real Emergency Physicians PLLC Physician Assistant Past Accepting new patients
Epilepsy Foundation of Texas Past Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861565046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 WESTCHESTER ST",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759017357",
            "telephone_number": "936-633-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 HIGHWAY 59 LOOP N",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773515703",
            "telephone_number": "936-329-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "EARL",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, TX

Sources for this page

Verify at the official NPI Registry.