Dr Tavia Denise Clark, MD in Gastonia, NC

Dr Tavia Denise Clark, MD is a medicare enrolled "Pediatrics" physician in Gastonia, North Carolina. Her current practice location is 2525 Court Dr, Gastonia, North Carolina. You can reach out to her office (for appointments etc.) via phone at (704) 834-2000.

Dr Tavia Denise Clark is licensed to practice in North Carolina (license number 2015-02140) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1851667380.

Contact Information

	Dr Tavia Denise Clark, MD
	2525 Court Dr, Gastonia, NC 28054-2140
	(704) 834-2000
	(704) 834-2500

Map and Direction

Physician's Profile

Full Name	Dr Tavia Denise Clark
Gender	Female
Speciality	Pediatrics
Location	2525 Court Dr, Gastonia, North Carolina
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1851667380
Provider Enumeration Date: 03/29/2012
Last Update Date: 08/23/2023

Medicare PECOS Information:

PECOS PAC ID: 5496034340
Enrollment ID: I20171211000538

Medical Identifiers

Medical identifiers for Dr Tavia Denise Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1851667380	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	264842 (Massachusetts)	Secondary
208000000X	Pediatrics	MD174941 (Oregon)	Secondary
208000000X	Pediatrics	MD60584128 (Washington)	Secondary
208000000X	Pediatrics	MD455243 (Pennsylvania)	Secondary
208000000X	Pediatrics	2015-02140 (North Carolina)	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. Dr Tavia Denise Clark allows following entities to bill medicare on her behalf.

Entity Name	Kapiolani Medical Center For Women & Children
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1548215692 PECOS PAC ID: 9830097914 Enrollment ID: O20031229000149

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 Tavia Denise 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
Dr Tavia Denise Clark, MD Po Box 744786, Atlanta, GA 30374-4786 Ph: (704) 834-2450	Dr Tavia Denise Clark, MD 2525 Court Dr, Gastonia, NC 28054-2140 Ph: (704) 834-2000

Reviews and Comments

Pediatrics Doctors in Gastonia, NC

Dr. Richard Derek Brugman, DO Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2907 Rousseau Ct, Gastonia, NC 28054 Phone: 980-421-7021 Fax: 980-407-5757
Jeffrey Michael Cook, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2544 Court Dr, Ste C, Gastonia, NC 28054 Phone: 704-867-5356
Russell Cox, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2544 Court Dr, Ste C, Gastonia, NC 28054 Phone: 704-867-5356
Cassady Michelaina Hossenlopp, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2544 Court Dr, Ste C, Gastonia, NC 28054 Phone: 704-867-5356
Dr. Sharon Roncevich Baxter, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 991 W Hudson Blvd, Gastonia, NC 28052 Phone: 704-853-5000
Margaret Lubega, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2644 Court Dr, Gastonia, NC 28054 Phone: 704-868-3664 Fax: 704-868-3665
Dr. Olivia Bridget Mijumbi, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 239 Wilmot Dr Ste A, Gastonia, NC 28054 Phone: 704-864-0303 Fax: 704-864-6070

Dr Tavia Denise Clark, MD - Medicare Pediatrics in Gastonia, NC