NPIMap

Individual provider Active NPI

Andrew Robert Clark, D.O.

  • Family Medicine Physician
  • Bradenton, FL
National Provider Identifier
1912988635
Registry record updated May 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS9370 Issued in FL
Practice address
5123 4TH Avenue Cir E
Bradenton, FL 34208-5620
Phone
(941) 744-5510
Fax
(941) 744-5166
NPI assigned
Nov 9, 2005
Last updated
May 15, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS9370 FL Primary

Addresses

Primary practice location

5123 4TH Avenue Cir E
Bradenton, FL 34208-5620

Mailing address

5123 4TH Avenue Cir E
Bradenton, FL 34208-5620
Phone (941) 744-5510

Other identifiers 2

IdentifierTypeStateIssuer
28803OtherFLBLUE CROSS
272670000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20050526000345 FL Practitioner - Family Practice 1951343235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cooper Family Medical PLLCGroup PAC ID 9931171782, 19 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

5123 4TH Ave Cir E
Bradenton, FL 34208-5620
Phone (941) 744-5510

7374 San Casa Dr
Englewood, FL 34224-8842
Phone (941) 417-5064

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions18
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS9370FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cooper Family Medical PLLC Family Medicine CurrentSince Jul 9, 2007 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5101 4th Avenue Cir E
Ste 200
Bradenton, FL 34208
Phone (941) 744-5510

5123 4th Avenue Cir E
Bradenton, FL 34208
Phone (941) 744-5510

Interoperability endpoints

  • Direct secure messaging: andrew.clark.1@26999.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/26999/brand/2/csg/1/fhir/r4

Organizations & group practices 2

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 5

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": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400112000000",
    "number": "1912988635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5123 4TH AVENUE CIR E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085620",
            "telephone_number": "941-744-5510",
            "fax_number": "941-744-5166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5123 4TH AVENUE CIR E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085620",
            "telephone_number": "941-744-5510",
            "fax_number": "941-744-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANDREW",
        "middle_name": "ROBERT",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2014-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "28803",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272670000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.