Jaclyn Clark, M.D.

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

License

C462356683177 Issued in MD

Practice address

550 1St Ave
New York, NY 10016-6402

Phone

(201) 321-2635

NPI assigned

May 20, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, MD2 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

Specialty

General Surgery

Education

New York University School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shock Trauma Associates PAGroup PAC ID 6800882317, 258 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Maryland Medical Center Hospital, Baltimore, MD, CCN 210002

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Shock Trauma Associates, P.a.

  • Emergency Care Clinic/Center
  • Baltimore, MD
  • NPI 1679512909

  DC

  Medicare reassignment Care Compare group NPD
• Dimensions Healthcare Associates, Inc.

  • Anesthesiology Physician
  • Largo, MD
  • NPI 1346354834

  DC

  Medicare reassignment NPD
• Dimensions Health Associates Dba University of Maryland Capital Region

  • Internal Medicine Physician
  • Oxon Hill, MD
  • NPI 1407486293
  NPD
• Dimensions Healthcare Associates Inc

  • Critical Care Medicine (Internal Medicine) Physician
  • Laurel, MD
  • NPI 1386706562

  Surgical Critical Care

  NPD
• University of Maryland Medical Center, LLC

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1174660120
  NPD (past)

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

• University of Maryland Medical Center, LLC

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1174660120
  Care Compare affiliation

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

{
    "created_epoch": "1369008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1861838682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402",
            "telephone_number": "201-321-2635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JACLYN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-20",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MD",
            "license": "C462356683177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Lauren Clark, PA-C
• Emma Clark
• Eunice Cheryle Clark, NP
• Gary Clark, LSCW
• Gregory Clark
• Jamilah Ellena Clark, LMSW
• Janet Rebecca Clark, OTR/L
• Jeanann Clark, PHYSICIAN ASSISTANT
• Jenifer Clark, PHD
• Joanne N.S. Clark, LCSW

• Surgical Critical Care Physician in New York, NY
• Providers in New York, NY by specialty
• Surgical Critical Care Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.