Jevin Clark, MD
Individual provider Active NPI Pediatrics Physician · Providence, RI
NPI 1912698648 · NPPES record last updated Jun 23, 2023
Key facts
- NPI
- 1912698648
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- CLP05853 (RI)
- Practice address
- 593 Eddy St
Providence, RI 02903-4923 - Phone
- (401) 444-4393
- NPI assigned
- May 15, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230530002389 | RI | Order and Referring Only - Pediatric Medicine |
6002273406 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifespan Corporation | Current | Accepting new patients |
Interoperability endpoints
- jclark217532@brownhealth.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | CLP05853 | RI | |
| Pediatrics Physician | 208000000X | CLP05853 | RI | Yes |
Addresses
Primary practice location
593 Eddy St
Providence, RI 02903-4923
Mailing address
593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4393
Other providers in Providence, RI
- Courtney Clark Bilodeau
- Lindsay Erin Clark Donat
- Melanie Beth Clark-Medyesy
- Aimee Elizabeth Clark
- Clara Clark
- Jonathan B. Clark
- Kerry A Clark
- Kristen M Clark
- Madelyn Isabel Clark
- Michael Clark
All providers in Providence, RI · Pediatrics Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.