NPIMap

Individual provider Active NPI

Richard Gary Clark, MD

  • Internal Medicine Physician
  • Jamestown, TN
National Provider Identifier
1962406793
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11080 Issued in TN
Practice address
100 S Duncan St
Jamestown, TN 38556-3009
Phone
(931) 879-5864
Fax
(931) 879-3903
NPI assigned
Jun 9, 2005
Last updated
Mar 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 11080 TN
Hospitalist Physician 208M00000X 11080 TN
Internal Medicine Physician 207R00000X 11080 TN Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20100603000658 TN Practitioner - Internal Medicine 8123157971 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
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, LLCGroup PAC ID 6305273392, 8 clinicians

Practice addresses (Care Compare)

100 S Duncan St
Jamestown, TN 38556-3009
Phone (931) 879-5864

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.1 of 100Reported as apm
Quality
65.16
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11080TNMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ambulatory Care Center of Wartburg Primary Care LLC Current Accepting new patients
Monterey Medical LLC CurrentSince Jul 22, 2023 Accepting new patients
Acute Care Clinics of America, LLC CurrentSince Oct 1, 2019 Accepting new patients
Cumberland Spine & Sport, LLC Past Accepting new patients
University Health System Inc Past Accepting new patients
Medical Observation Services LLC Emergency Medicine Past Accepting new patients
Volunteer Medical Group, P.C. Emergency Medicine 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
Monterey, TN 38574
Phone (931) 839-2224

400 W Crawford Ave
Ste C
Monterey, TN 38574
Phone (931) 839-2224

Organizations & group practices 7

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 3

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1962406793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2861",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385572861",
            "telephone_number": "931-879-5864",
            "fax_number": "931-879-3903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S DUNCAN ST",
            "city": "JAMESTOWN",
            "state": "TN",
            "postal_code": "385563009",
            "telephone_number": "931-879-5864",
            "fax_number": "931-879-3903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RICHARD",
        "middle_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "11080",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TN",
            "license": "11080",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "11080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, TN

Sources for this page

Verify at the official NPI Registry.