NPIMap

Individual provider Active NPI

Kenneth A Clark, MD

  • Internal Medicine Physician
  • Galax, VA
National Provider Identifier
1902880370
Registry record updated Oct 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101-041662 Issued in VA
Practice address
199 Hospital Dr
Suite 5
Galax, VA 24333-2454
Phone
(276) 236-6136
NPI assigned
Nov 30, 2005
Last updated
Oct 24, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101-041662 VA Primary

Addresses

Primary practice location

199 Hospital Dr
Suite 5
Galax, VA 24333-2454

Mailing address

199 Hospital Dr
Suite 5
Galax, VA 24333-2454

Other identifiers 4

IdentifierTypeStateIssuer
005826781MedicaidVA
010044065MedicaidVA
005826772MedicaidVA
010022100MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20031210001122 VA Practitioner - Internal Medicine 1951207836 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of South Florida College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Giles Community HospitalGroup PAC ID 3678670221, 223 clinicians

Practice addresses (Care Compare)

159 Hartley Way
Pearisburg, VA 24134-2471
Phone (540) 921-6000

200 Hospital Dr
Galax, VA 24333-2227
Phone (276) 236-8181

544 E Stuart Dr
Suite D
Galax, VA 24333-2231
Phone (276) 236-6136

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy236
Upper gastrointestinal (GI) endoscopy for acid reflux265

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101-041662VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Giles Community Hospital Current Accepting new patients
Carilion Healthcare Corporation CurrentSince Jan 1, 2000 Accepting new patients
Carilion Giles Community Hospital CurrentSince Aug 1, 2020 Accepting new patients
Carilion Healthcare Corporation CurrentSince Jan 1, 2000 Accepting new patients
Carilion Giles Community Hospital CurrentSince Aug 1, 2020 Accepting new patients
Apogee Medical Group Virginia, PC Internal Medicine CurrentSince Nov 26, 2012 Accepting new patients

Locations

2900 Lamb Cir
Ste 250
Christiansburg, VA 24073
Phone (540) 639-9071

199 Hospital Dr
Galax, VA 24333
Phone (276) 236-5181

199 Hospital Dr
#7
Galax, VA 24333
Phone (276) 236-5181

199 Hospital Dr
Ste 5
Galax, VA 24333
Phone (276) 236-6136

199 Hospital Dr
Ste 7
Galax, VA 24333
Phone (276) 236-5181

200 Hospital Dr
Galax, VA 24333
Phone (276) 236-6011

416 S Main St
Hillsville, VA 24343
Phone (276) 236-5181

416 S Main St
Ste A
Hillsville, VA 24343
Phone (540) 728-7731

320 Hospital Dr
Martinsville, VA 24112
Phone (276) 666-7200

159 Hartley Way
Pearisburg, VA 24134
Phone (540) 921-6000

213 S Jefferson St
Ste 625
Roanoke, VA 24011
Phone (540) 224-5677

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

Interoperability endpoints

  • Direct secure messaging: kclark13025@direct.carilionclinic.org

Organizations & group practices 6

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414108800000",
    "number": "1902880370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 HOSPITAL DR",
            "address_2": "SUITE 5",
            "city": "GALAX",
            "state": "VA",
            "postal_code": "243332454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 HOSPITAL DR",
            "address_2": "SUITE 5",
            "city": "GALAX",
            "state": "VA",
            "postal_code": "243332454",
            "telephone_number": "276-236-6136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2014-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101-041662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005826781",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010044065",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005826772",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010022100",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Galax, VA

Sources for this page

Verify at the official NPI Registry.