JACK CLARK D.O.
NPI 1073563847
Internal Medicine - Rheumatology in Cape Coral, FL

Q: What is Jack Clark's NPI number?

The NPI number for Jack Clark is 1073563847. It was assigned to this individual provider in the NPPES registry on May 11, 2006.

Q: What is Jack Clark's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Rheumatology, with taxonomy code 207RR0500X.

Q: When was this NPI record last updated?

The NPPES record for Jack Clark was last updated on September 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.

Active since May 11, 2006PECOS Enrolled

1528 DEL PRADO BLVD S, CAPE CORAL, FL 33990(239) 458-3338(239) 458-0666 Get Directions Write a Review

NPPES record last updated: September 29, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 29, 2021, Feb 11, 2019, Aug 17, 2016 (3 updates tracked since 2016).

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About Jack Clark D.o. NPPES

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

JACK CLARK D.O. (NPI 1073563847) is an individual rheumatology provider in Cape Coral, Florida, licensed in Florida (OS8284) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1073563847

Entity TypeIndividualMale

Primary Taxonomy207RR0500X

Provider Legal NameJACK CLARKCredential: D.O.

Location Address1528 DEL PRADO BLVD SCape Coral, FL 33990-3798

Mailing Address2675 Winkler Ave Fl 2Fort Myers, FL 33901-9342 · (877) 856-3774 · Fax (239) 599-2612

Phone(239) 458-3338

Fax(239) 458-0666

Sole ProprietorNo

Enumeration DateMay 11, 2006

Last NPPES UpdateSeptember 29, 20213 updates tracked since enumeration

NPPES CertifiedSeptember 29, 2021

✔ NPI 1073563847 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · RheumatologyAllopathic & Osteopathic Physicians

Taxonomy Code207RR0500X

License✔ Licensed in FL · OS8284

Definition

An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases.

1528 DEL PRADO BLVD S, Cape Coral, FL 33990

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Other Identifiers 1

Medicaid272380800FL

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jack Clark D.o. 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.

Medicare Billing Reassignment

Medicare enrollment records show Jack Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Millennium Physician Group LLC

7.7 mi

Family Medicine

6321 DANIELS PKWY
Fort Myers, FL 33912

Reassigned Medicare billing, Florida enrollment
1,278 clinicians in this Medicare group

NPI 1811122880 (877) 856-3774

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 11

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

808 services356 patients

Insertion of needle into vein for collection of blood sample 36415

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

206 services122 patients

Blood test, comprehensive group of blood chemicals 80053

A comprehensive group of blood chemicals test, also known as a comprehensive metabolic panel, is a blood test that measures your sugar level, electrolyte and fluid balance, kidney function, and liver function. This helps to check your body's overall health.

161 services107 patients

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count 85025

A Complete Blood Cell Count is a common test that measures various components of the blood, including red cells (carry oxygen), white cells (fight infection), and platelets (help blood clot). An automated test ensures accuracy. The differential count provides detailed information about white cell types.

160 services105 patients

Measurement c-reactive protein for detection of infection or inflammation 86140

C-reactive protein (CRP) test is a blood test that checks for signs of inflammation or infection in the body. High levels of CRP often suggest that there's inflammation or a bacterial infection. This test helps in monitoring and managing conditions like arthritis and heart disease.

112 services87 patients

Aspiration and/or injection of fluid from large joint 20610

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

54 services32 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33990 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$135.56 typical visit price

range $58.56 – $179.05

Typical copayment $33.89 (range $14.64 – $44.76)

Most-billed visit code 99204

Established Patient

$103.21 typical visit price

range $18.44 – $144.68

Typical copayment $25.80 (range $4.61 – $36.17)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

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