Physician Compare National (NPI:1902224231)

HEALTHCARE PROVIDER: MATTHEW JOHN CLARK M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1902224231
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7214220714
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200625002645
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CLARK
	Individual professional last name
Provider First Name	MATTHEW
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	APP OF TENNESSEE ED PLLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	8123251766
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	172
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2000 BROOKSIDE DR
	Group Practice or individual's line 1 address
City	KINGSPORT
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376604627
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6292037320
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	520096
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WHEATON FRANCISCAN HEALTHCARE ALL SAINTS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	440012
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	WELLMONT BRISTOL REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	440017
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	WELLMONT HOLSTON VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y