Richard Gary Clark, MD
Individual provider Active NPI Internal Medicine Physician · Jamestown, TN
NPI 1962406793 · NPPES record last updated Mar 25, 2024
Key facts
- NPI
- 1962406793
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 11080 (TN)
- Practice address
- 100 S Duncan St
Jamestown, TN 38556-3009 - Phone
- (931) 879-5864
- Fax
- (931) 879-3903
- NPI assigned
- Jun 9, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- University of Tennessee, HSC, College of Medicine, 1977
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Acute Care Clinics of America, LLC
Practice addresses (Care Compare)
100 S Duncan St
Jamestown, TN 38556-3009
Phone (931) 879-5864
Hospital & facility affiliations
- Quality Home Health
- Amedisys Home Health
- Cumberland Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.1 of 100
- Quality
- 65.16
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- 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 |
|---|---|---|---|---|
| I20100603000658 | TN | Practitioner - Internal Medicine | 8123157971 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11080 | TN | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Monterey Medical LLC | Current |
Accepting new patients | |
| Acute Care Clinics of America, LLC | Current |
Accepting new patients | |
| Ambulatory Care Center of Wartburg Primary Care LLC | Current | Accepting new patients | |
| University Health System Inc | Past | Accepting new patients | |
| Volunteer Medical Group, P.C. | Emergency Medicine | Past | Accepting new patients |
| Medical Observation Services LLC | Emergency Medicine | Past | Accepting new patients |
| Cumberland Spine & Sport, LLC | Past | Accepting new patients |
Locations
102 Old Jefferson St
Celina, TN 38551
Phone (931) 243-3576
6845 S York Hwy
Clarkrange, TN 38553
Phone (931) 863-3323
100 S Duncan St
Jamestown, TN 38556
Phone (931) 752-2273
400 W Crawford Ave
Ste C
Monterey, TN 38574
Phone (931) 839-2224
400 W Crawford Ave
Monterey, TN 38574
Phone (931) 839-2224
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 11080 | TN | |
| Hospitalist Physician | 208M00000X | 11080 | TN | |
| Internal Medicine Physician | 207R00000X | 11080 | TN | Yes |
Addresses
Primary practice location
100 S Duncan St
Jamestown, TN 38556-3009
Mailing address
PO Box 2861
Crossville, TN 38557-2861
Phone (931) 879-5864
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4053283 | Medicaid | TN |
Other providers in Jamestown, TN
- Nicholas Charles Celeslie
- Chad a Conatser MD PLLC
- Kevin Arthur Chermak
- Michael A Choate
- Sarah Clapp
- Christie Clarke
- Norma Collins
- Thomas L. Collins
- Linda Conatser
- McKael Conatser
All providers in Jamestown, TN · Internal Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2024. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.