John E Clark

Primary specialty

SpecialistTaxonomy code 174400000X

License

08015R Issued in LA

Practice address

4545 Bluebonnet Blvd
Baton Rouge, LA 70809-5600

Phone

(225) 766-2311

Fax

(225) 767-7134

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2018 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Stanocola Employees Medical and Hospital Association, Inc

  • Specialist
  • Baton Rouge, LA
  • NPI 1275694804
  NPD (past)

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242604800000",
    "number": "1881736593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84358",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708844358",
            "telephone_number": "225-766-2311",
            "fax_number": "225-767-7134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 BLUEBONNET BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708095600",
            "telephone_number": "225-766-2311",
            "fax_number": "225-767-7134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOHN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2009-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "LA",
            "license": "08015R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1388483",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erika Clark, NREMT
• Evelyn Elizabeth Clark
• Hollis Anne Clark, DDS
• Jamie Sartwell Clark, GSW,LCSW
• Jessica Clark
• Lacey Jane Clark
• Latoya S Clark, LPN
• Latrenda W Clark
• Lemuria Atlantis Clark
• Mada Clark

• Specialist in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.