Justin Clark, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

215216 Issued in MA

Practice address

99 Campus Ave
Suite 303
Lewiston, ME 04240-6045

Phone

(207) 782-5424

Fax

(207) 782-1136

NPI assigned

Jan 4, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/4271/brand/1/csg/21/fhir/r4

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.

• Advanced Wound Care Center, LLC

  • Specialist
  • Portland, ME
  • NPI 1548534258
  NPD (past)

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329264000000",
    "number": "1962480459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1638",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122011638",
            "telephone_number": "207-777-4111",
            "fax_number": "207-783-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 CAMPUS AVE",
            "address_2": "SUITE 303",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042406045",
            "telephone_number": "207-782-5424",
            "fax_number": "207-782-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2012-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "215216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Chupka, RPH, PHARM D, BCACP
• William H Churchill, LADC
• Cindy L. Tuttle, LCSW, PA
• Cindy Mailhot Incorporated
• City of Lewiston School Department
• Peter L Clark, DO
• Sarah H Clark, RN
• Sheri A Clark, L.C.P.C.
• Wendy L Clarke, LMSW/CC
• Edmund Claxton Jr., MD

• Surgery Physician in Lewiston, ME
• Providers in Lewiston, ME by specialty
• Surgery Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.