Shane Chamberlain Clark, MD is a medicare enrolled "Dermatology" physician in Wooster, Ohio. He went to Ohio State University College Of Medicine and graduated in 2009 and has 16 years of diverse experience with area of expertise as Dermatology. He is a member of the group practice Dermatologists Of Southwestern Ohio, Llc and his current practice location is
347 W Milltown Rd Ste B, Wooster, Ohio. You can reach out to his office (for appointments etc.) via phone at
(330) 345-1540.
Shane Chamberlain Clark is licensed to practice in Ohio (license number 35121081) 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 1548495336.
Physician's Profile
| Full Name | Shane Chamberlain Clark |
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| Gender | Male |
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| Speciality | Dermatology |
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| Experience | 16 Years |
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| Location | 347 W Milltown Rd Ste B, Wooster, Ohio |
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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:
- Shane Chamberlain Clark attended and graduated from Ohio State University College Of Medicine in 2009
NPI Data:
- NPI Number: 1548495336
- Provider Enumeration Date: 05/21/2009
- Last Update Date: 04/09/2024
Medicare PECOS Information:
- PECOS PAC ID: 6800036963
- Enrollment ID: I20130712000591
Medical Identifiers
Medical identifiers for Shane Chamberlain Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1548495336 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207N00000X | Dermatology | 35121081 (Ohio) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Dermatologists Of Southwestern Ohio, Llc | 7113973041 | 84 |
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. Shane Chamberlain Clark allows following entities to bill medicare on his behalf.
| Entity Name | Dermatologists Of Southwestern Ohio, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1801819883
PECOS PAC ID: 7113973041
Enrollment ID: O20050323001436 |
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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. Shane Chamberlain 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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Shane Chamberlain Clark, MD
347 W Milltown Rd Ste B,
Wooster, OH 44691-7216
Ph: (330) 345-1540 | Shane Chamberlain Clark, MD
347 W Milltown Rd Ste B,
Wooster, OH 44691-7216
Ph: (330) 345-1540 |
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