Active NPI
Vivian Elizabeth Clark, MD
- Obstetrics & Gynecology Physician
- Chapel Hill, NC
National Provider Identifier
1942277652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 30614
- Practice address
- 120 Conner Dr
#101 Chapel Hill OB GYN
Chapel Hill, NC 27514 - Phone
- (919) 942-8571
- Fax
- (919) 942-6355
- NPI assigned
- Mar 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 30614 | NC | Primary |
Addresses
Primary practice location
120 Conner Dr
#101 Chapel Hill OB GYN
Chapel Hill, NC 27514
Mailing address
120 Conner Drive
# 101
Chapel Hill, NC 27514
Phone (919) 942-8571
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22171 | Other | NC | BCBS |
| 22179 | Other | NC | MEDCOST |
| 1284188003 | Other | NC | UHC |
| 154773 | Other | NC | WELLPATH |
| 7922717 | Medicaid | NC | |
| 562142486 | Other | NC | BEECHSTREET |
| 2855944 | Other | NC | CIGNA |
| 2276981 | Other | NC | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411344000000",
"number": "1942277652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 CONNER DRIVE",
"address_2": "# 101",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "27514",
"telephone_number": "919-942-8571",
"fax_number": "919-942-6355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 CONNER DR",
"address_2": "#101 CHAPEL HILL OB GYN",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "27514",
"telephone_number": "919-942-8571",
"fax_number": "919-942-6355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "VIVIAN",
"middle_name": "ELIZABETH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-01",
"last_updated": "2014-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "NC",
"license": "30614",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "22171",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "22179",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "1284188003",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLPATH",
"identifier": "154773",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7922717",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEECHSTREET",
"identifier": "562142486",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2855944",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2276981",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chapel Hill, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.