DR. EDWARD PETERSEN CLACK (NPI# 1659629053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659629053 |
| Entity Type | Individual |
| Full Name | DR. EDWARD PETERSEN CLACK |
| Credential | DO |
| Practice Address |
68 Darst Rd Beavercreek OH 45440-3442 |
| Practice Telephone | 9375310132 |
| Practice Fax Number | 9375310134 |
| Mailing Telephone | 9375310132 |
| Mailing Fax Number | 9375310134 |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2018-10-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 34.011463 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0122811 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1323 W 3rd St, Dayton, OH 454026714 | 9375869733 |
| Street Address |
68 DARST RD |
| City | BEAVERCREEK |
| State | OH |
| Zip Code | 45440-3442 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508869025 | James E Foster Jr. | Family Medicine | 68 Darst Rd, Beavercreek, OH 45440-3442 | 2005-05-30 |
| 1356992028 | Zachary James Hale | Nurse Practitioner | 68 Darst Rd, Beavercreek, OH 45440-3442 | 2019-09-24 |
| 1184083107 | Lauren Elizabeth Sillaman | Nurse Practitioner | 68 Darst Rd, Beavercreek, OH 45440-3442 | 2016-02-18 |
| 1376727412 | Beth Ann Shutte | Family Medicine | 68 Darst Rd, Beavercreek, OH 45440-3442 | 2007-12-26 |
| 1750384277 | Lisa K Heinemeyer-foster | Family Medicine | 68 Darst Rd, Beavercreek, OH 45440-3442 | 2005-05-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427657568 | Jason Michael Knippen | Pharmacist | 5400 Cornerstone, Centerville, OH 45440 | 2020-10-20 |
| 1184222564 | Kimberly Downs | Pharmacist | 5400 North Cornerstone Blvd, Centerville, OH 45440 | 2020-10-16 |
| 1659902153 | Caryn Hoffman | Pharmacist | 5400 Cornerstone Blvd, Centerville, OH 45440 | 2020-02-03 |
| 1023673100 | Katren Elizabeth Clark | Psychologist | 70 Birch Alley, Suite 240, Dayton, OH 45440 | 2019-05-05 |
| 1649784737 | Amy Lynn Winstead | Dietitian, Registered | 5721 Bigger Road, Kettering, OH 45440 | 2017-11-28 |
| 1104245455 | Aprscp, Inc. | Hearing Instrument Specialist | 3341 East Stroop Road, Kettering, OH 45440 | 2014-04-15 |
| 1457601858 | Victoria L Saylor | Pharmacy Technician | 4480 Indianripple Rd, Dayton, OH 45440 | 2012-09-12 |
| 1528368644 | Sara Jankowski | Art Therapist | 5178 Scarsdale Dr., Kettering, OH 45440 | 2010-10-22 |
| 1356651012 | Senior Options Group | Home Health | 4025 Marshall Road, Kettering, OH 45440 | 2010-10-15 |
| 1417106345 | Sheenu Goel | Dentist | 4235 Indian Ripple Rd., Suite 200a, Dayton, OH 45440 | 2008-09-16 |
| Find all providers in zip 45440 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760019475 | Carehere LLC | Family Medicine | 3040 Kemp Rd Ste 100, Beavercreek, OH 45431-2644 | 2020-03-24 |
| 1740713254 | Kelsey Mayrand | Family Medicine | 1244 Meadow Bridge Dr Ste 100, Beavercreek, OH 45434-6388 | 2017-04-11 |
| 1760895940 | Jonathan A Clifford | Family Medicine | 2510 Commons Blvd Ste 110, Beavercreek, OH 45431-3821 | 2014-06-05 |
| 1881977171 | Alim Vivanco | Family Medicine | 2641 Hibiscus Way, Apt 312, Beavercreek, OH 45431-2393 | 2011-09-22 |
| 1639465586 | Melanie C Raffoul | Family Medicine | 1911 Old Fairfield Rd Ste 110a, Beavercreek, OH 45432-2754 | 2011-06-20 |
| 1528221157 | Green and Guirnalda Family Health Center | Family Medicine | 3359 Kemp Rd Ste 100, Beavercreek, OH 45431-2565 | 2008-07-03 |
| 1760661367 | Matthew D Moore LLC | Family Medicine | 2141 North Fairfield Road, Suite C, Beavercreek, OH 45431-2579 | 2007-10-31 |
| 1710066030 | Jane Diane Morford | Family Medicine | 1896 Shady Ln, Beavercreek, OH 45432-2063 | 2006-11-06 |
| 1316058894 | Joseph Scott Leithold | Family Medicine | 4235 Indian Ripple Road, Ste 210, Beavercreek, OH 45440 | 2006-08-31 |
| 1437198066 | Lisa Renee Vantrease | Family Medicine | 2145 N Fairfield Rd Ste 100, Beavercreek, OH 45431 | 2006-06-06 |
| Find all providers in BEAVERCREEK | ||||
| City | BEAVERCREEK |
| Zip Code | 45440 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.