Shane B Clark, DO

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

OS21375 Issued in FL

Practice address

2310 Village Square Pkwy Ste 106C
Fleming Island, FL 32003-6409

Phone

(904) 202-7300

Fax

(904) 202-2754

NPI assigned

Jun 27, 2018

Last updated

Apr 30, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Hematology/Oncology

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Baptist MD Anderson Cancer Physicians IncGroup PAC ID 5991932063, 115 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088

Merit-based Incentive Payment System (MIPS)

Final score

85.84 of 100Reported as group

Quality

73.65

Promoting interoperability

100

Improvement activities

40

Cost

74.43

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sclark187035@baptisthealthsystemjacksonville.direct-ci.com

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

• Baptist MD Anderson Cancer Physicians Inc

  dba Baptist MD Anderson Cancer Physicians

  • Hematology & Oncology Physician
  • Jacksonville, FL
  • NPI 1538593124
  Medicare reassignment Care Compare group NPD
• Baptist MD Anderson Cancer Physicians

  • Radiation Oncology Physician
  • Fleming Island, FL
  • NPI 1710664206

  Hematology & Oncology

  NPD
• Baptist MD Anderson Cancer Physicians Inc

  • Hematology & Oncology Physician
  • Fleming Island, FL
  • NPI 1821866880
  NPD
• Baptist MD Anderson Cancer Physicians Inc

  • Surgery Physician
  • Jacksonville, FL
  • NPI 1356119309

  Hematology

  NPD (past)

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

• Southern Baptist Hospital of Florida Inc

  dba Baptist Medical Center

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1578620449
  Care Compare affiliation

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1902391477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746654",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746654",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 VILLAGE SQUARE PKWY STE 106C",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320036409",
            "telephone_number": "904-202-7300",
            "fax_number": "904-202-2754"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Palm Ave Ste 700",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322078457",
            "country_code": "US",
            "telephone_number": "904-202-7300",
            "fax_number": "904-202-2754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANE",
        "middle_name": "B",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-27",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "FL",
            "license": "OS21375",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "FL",
            "license": "OS21375",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "FL",
            "license": "OS21375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corallynn S Chesser
• Sian Chisholm, M.D.
• Elizabeth Susan Chouinard, APRN
• Gabrielle Cintron, OD
• Heather Brooke Clair
• Hannah Clayton
• Nichelle Clayton
• Nichole E Clayton, PT, DPT
• Coast Dental P.a. (Coast Dental-Fleming Island)
• Jason Cobb

• Hematology & Oncology Physician in Fleming Island, FL
• Providers in Fleming Island, FL by specialty
• Hematology & Oncology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; 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.