Cory Douglas Clark, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.006996RX Issued in OH

Practice address

7426 Beechmont Ave Unit 212
Cincinnati, OH 45255-4105

Phone

(513) 232-2400

NPI assigned

Oct 12, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vein Center of Cincinnati LLCGroup PAC ID 6901235613, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Vein Center of Cincinnati LLC

  • Vascular Surgery Physician
  • Cincinnati, OH
  • NPI 1467084269
  Medicare reassignment Care Compare group
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  OH

  Medicare reassignment

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

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1932861473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7426 BEECHMONT AVE UNIT 212",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452554105",
            "telephone_number": "513-232-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7426 BEECHMONT AVE UNIT 212",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452554105",
            "telephone_number": "513-232-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CORY",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-12",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.006996RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol L Clark
• Charles Clark Jr.
• Chelsea Clark
• Cheyenne M Clark
• Clarence Clark Jr., NURSES AID
• Daniel James Clark, M.D., PHD
• Danielle L. Clark, M.D.
• Deanna Michelle Clark
• Dena Therese Clark, CNP
• Denise Nogueira Clark

• Physician Assistant in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; 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.