Leroy S Clark, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G14247 Issued in CA

Practice address

18344 Clark Street
Suite 101
Tarzana, CA 91356

Phone

(818) 881-9811

Fax

(818) 881-1638

NPI assigned

Jun 6, 2006

Last updated

Nov 27, 2007By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Encino Hospital Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Encino, CA
  • NPI 1750537494
  NPD (past)
• South Valley Imaging

  dba South Valley Imaging Center

  • Diagnostic Radiology Physician
  • Tarzana, CA
  • NPI 1154357531
  NPD (past)
• South Valley Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Tarzana, CA
  • NPI 1508813619
  NPD (past)
• SVR Imaging LLC

  • Diagnostic Radiology Physician
  • Encino, CA
  • NPI 1134456841
  NPD (past)

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1982643508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16699",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926236699",
            "telephone_number": "949-263-8620",
            "fax_number": "949-263-1639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18344 CLARK STREET",
            "address_2": "SUITE 101",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "91356",
            "telephone_number": "818-881-9811",
            "fax_number": "818-881-1638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LEROY",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G14247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G142470",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G142470",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Church Adult Day Health Care Center Inc
• Toni Cicatello
• Jadalynn Cirillo
• Rodrigo Cirqueira
• Ashley Lynn Clark, PA
• Jennifer C Clarke
• Scott Aaron Cleveland
• Clifford Feldman Group Practice
• Clinical Care Pharmacy PC
• Pamela Sirinthon Cloribel, PHARM.D.

• Diagnostic Radiology Physician in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; 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.