Dr Dwayne Charles Clark, MD is a medicare enrolled "Family Medicine" physician in N Fond Du Lac, Wisconsin. He went to Duke University School Of Medicine and graduated in 1994 and has 31 years of diverse experience with area of expertise as Family Practice. He is a member of the group practice Agnesian Healthcare Inc and his current practice location is
723 Park Ridge Ln, N Fond Du Lac, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(920) 926-8600.
Dr Dwayne Charles Clark is licensed to practice in Wisconsin (license number 48855) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1184695975.
Physician's Profile
| Full Name | Dr Dwayne Charles Clark |
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| Gender | Male |
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| Speciality | Family Practice |
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| Experience | 31 Years |
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| Location | 723 Park Ridge Ln, N Fond Du Lac, Wisconsin |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Dwayne Charles Clark attended and graduated from Duke University School Of Medicine in 1994
NPI Data:
- NPI Number: 1184695975
- Provider Enumeration Date: 01/30/2006
- Last Update Date: 10/28/2020
Medicare PECOS Information:
- PECOS PAC ID: 4284645391
- Enrollment ID: I20060605000046
Medical Identifiers
Medical identifiers for Dr Dwayne Charles Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1184695975 | NPI | - | NPPES |
| P00319962 | Other | WI | RAILROAD MEDICARE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 48855 (Wisconsin) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Agnesian Healthcare Inc | 1658289624 | 335 |
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. Dr Dwayne Charles Clark allows following entities to bill medicare on his behalf.
| Entity Name | Agnesian Healthcare Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1346228541
PECOS PAC ID: 1658289624
Enrollment ID: O20031104000263 |
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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. Dr Dwayne Charles Clark 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 |
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Dr Dwayne Charles Clark, MD
420 E Division St,
Fond Du Lac, WI 54935-4560
Ph: (920) 926-8340 | Dr Dwayne Charles Clark, MD
723 Park Ridge Ln,
N Fond Du Lac, WI 54937-1385
Ph: (920) 926-8600 |
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