DR. CLARK CONSTANTINE INGRAM MD
NPI 1063115848
Student in an Organized Health Care Education/Training Program in Columbus, OH

Active since March 22, 2023PECOS Enrolled
395 W 12TH AVE STE 662, COLUMBUS, OH 43210(614) 366-5978 Get Directions Write a Review

NPPES record last updated: March 22, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Clark Constantine Ingram Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CLARK CONSTANTINE INGRAM MD (NPI 1063115848) is an individual student in an organized health care education/training program in Columbus, Ohio and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063115848
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. CLARK CONSTANTINE INGRAMCredential: MD
Location Address395 W 12TH AVE STE 662Columbus, OH 43210-1267
Mailing Address395 W 12th Ave Ste 662Columbus, OH 43210-1267
Sole ProprietorNo
Enumeration DateMarch 22, 2023
NPPES CertifiedMarch 22, 2023
NPI 1063115848 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
395 W 12TH AVE STE 662, Columbus, OH 43210

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Clark Constantine Ingram Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Student in an Organized Health Care Education/Training Program
395 W 12TH AVE STE 662
COLUMBUS, OH 43210
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE STE 662
COLUMBUS, OH 43210
Hospitalist
395 W 12TH AVE STE 662
COLUMBUS, OH 43210
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE STE 662
COLUMBUS, OH 43210
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE STE 662
COLUMBUS, OH 43210
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE STE 662
COLUMBUS, OH 43210
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE STE 662
COLUMBUS, OH 43210
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE STE 662
COLUMBUS, OH 43210

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clark Ingram's NPI number?

The NPI number for Clark Ingram is 1063115848. It was assigned to this individual provider in the NPPES registry on March 22, 2023.

Where is Clark Ingram located?

Clark Ingram practices at 395 W 12th Ave Ste 662, Columbus, OH 43210. The listed phone number is (614) 366-5978.

What is Clark Ingram's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Clark Ingram enrolled in Medicare?

Yes. Clark Ingram is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Clark Ingram was last updated on March 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.