Clark Calvin Anderson, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in San Antonio, Texas. His current practice location is
4502 Medical Dr, San Antonio, Texas. You can reach out to his office (for appointments etc.) via phone at
(920) 460-8927.
Clark Calvin Anderson is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1104485770.
Physician's Profile
Full Name | Clark Calvin Anderson |
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Gender | Male |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 4502 Medical Dr, San Antonio, Texas |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1104485770
- Provider Enumeration Date: 06/07/2019
- Last Update Date: 06/25/2024
Medicare PECOS Information:
- PECOS PAC ID: 6608103841
- Enrollment ID: I20240808000624
Medical Identifiers
Medical identifiers for Clark Calvin Anderson such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1104485770 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207R00000X | Internal Medicine | NONE (North Carolina) | Secondary |
207R00000X | Internal Medicine | 0101281056 (Virginia) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Clark Calvin Anderson allows following entities to bill medicare on his behalf.
Entity Name | Bon Secours Medical Group Richmond Specialty Care Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1477112225 PECOS PAC ID: 8022440056 Enrollment ID: O20191113002170 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Clark Calvin Anderson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Clark Calvin Anderson, MD 9666 Criswell Crk, San Antonio, TX 78251-3537 Ph: (920) 460-8927 | Clark Calvin Anderson, MD 4502 Medical Dr, San Antonio, TX 78229 Ph: (920) 460-8927 |
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