CLARK CALVIN ANDERSON MD
NPI 1104485770
Student in an Organized Health Care Education/Training Program in San Antonio, TX

Active since June 07, 2019PECOS EnrolledAccepts Medicare Assignment
4502 MEDICAL DR, SAN ANTONIO, TX 78229(920) 460-8927 Get Directions Write a Review

NPPES record last updated: June 25, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 25, 2024, Jun 13, 2019, Jun 7, 2019 (3 updates tracked since 2019).

About Clark Calvin Anderson Md NPPES

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

CLARK CALVIN ANDERSON MD (NPI 1104485770) is an individual student in an organized health care education/training program in San Antonio, Texas and active in the NPI registry since June 2019. He is enrolled in Medicare PECOS, is affiliated with Bon Secours St Marys Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1104485770
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameCLARK CALVIN ANDERSONCredential: MD
Location Address4502 MEDICAL DRSan Antonio, TX 78229
Mailing Address9666 Criswell CrkSan Antonio, TX 78251-3537 · (920) 460-8927
Sole ProprietorNo
Medical School CMSTexas Tech University Health Science Center School Of MedicineGraduated 2019
Enumeration DateJune 7, 2019
Last NPPES UpdateJune 25, 20243 updates tracked since enumeration
NPPES CertifiedJuly 18, 2023
NPI 1104485770 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

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.
Also ListedInternal MedicineTaxonomy 207R00000X · License NONE (NC), 0101281056 (VA)
4502 MEDICAL DR, San Antonio, TX 78229

Secondary Practice Locations 2

Location 11 Medical Center BlvdWinston Salem, NC 27157-0001 · Phone (336) 716-2011
Location 2210 Medical Park Blvd Ste 100Petersburg, VA 23805-9348 · Phone (804) 765-5850 · Fax (804) 765-5870

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Clark Calvin Anderson Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6608103841
PECOS Enrollment IDI20240808000624
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.

Areas of Expertise CMS Part B claims 7

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.

Calculation of radiation therapy dose 77300
Radiation therapy dose calculation is a process to determine the exact amount of radiation needed to treat a specific area in the body. This calculation helps ensure the treatment is effective while minimizing harm to healthy tissues. It's a key part of planning your radiation therapy.
63 services18 patients
Ct guidance for insertion of radiation therapy fields 77014
CT guidance for insertion of radiation therapy fields involves using a CT scan to accurately map the area of your body where radiation will be applied. This ensures the radiation targets only the necessary area, minimizing impact to healthy tissues.
60 services14 patients
Radiation treatment management, 5 treatment sessions 77427
Radiation treatment management involves a series of 5 sessions where targeted radiation is used to destroy or shrink cancer cells in your body. Each session is carefully planned to maximize effectiveness while minimizing harm to healthy tissues. You may experience side effects which will be closely monitored and managed for your comfort.
44 services21 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
20 services20 patients
Complex radiation therapy planning 77263
Complex radiation therapy planning is a process to determine the most effective way to deliver radiation to a specific area in your body. It involves detailed imaging to map your body's structure, allowing for precise targeting of cancer cells while sparing healthy tissue.
18 services18 patients
Design and construction of radiation treatment device for high precision radiation therapy 77338
A radiation treatment device is custom-made for each patient to target cancer cells with high precision. It's designed to focus radiation on the tumor, sparing healthy tissue. This process ensures effective therapy while minimizing side effects.
15 services12 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Bon Secours St Marys Hospital

Acute Care Hospitals · Richmond, VA
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number490059
Location5801 Bremo RdRichmond, VA 23226 · Richmond City County
Emergency services Birthing friendly

Bon Secours Southside Medical Center

Acute Care Hospitals · Petersburg, VA
2/5 CMS rating
OwnershipProprietary
CMS Certification Number490067
Location200 Medical Park BoulevardPetersburg, VA 23805 · Petersburg City County
Emergency services Birthing friendly

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.

Internal Medicine (Cardiovascular Disease)
4502 MEDICAL DR
SAN ANTONIO, TX 78229
Student in an Organized Health Care Education/Training Program
4502 MEDICAL DR
SAN ANTONIO, TX 78229
Student in an Organized Health Care Education/Training Program
4502 MEDICAL DR
SAN ANTONIO, TX 78229
Physical Therapy Assistant
4502 MEDICAL DR
SAN ANTONIO, TX 78229
Nurse Anesthetist, Certified Registered
4502 MEDICAL DR
SAN ANTONIO, TX 78229
Nurse Anesthetist, Certified Registered
4502 MEDICAL DR
SAN ANTONIO, TX 78229
Pharmacist
4502 MEDICAL DR
SAN ANTONIO, TX 78229
Hospitalist
4502 MEDICAL DR
SAN ANTONIO, TX 78229

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 Anderson's NPI number?

The NPI number for Clark Anderson is 1104485770. It was assigned to this individual provider in the NPPES registry on June 7, 2019.

Where is Clark Anderson located?

Clark Anderson practices at 4502 Medical Dr, San Antonio, TX 78229. The listed phone number is (920) 460-8927.

What is Clark Anderson'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 Anderson enrolled in Medicare?

Yes. Clark Anderson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Clark Anderson affiliated with any hospitals?

According to CMS data, Clark Anderson is affiliated with Bon Secours St Marys Hospital and Bon Secours Southside Medical Center.

When was this NPI record last updated?

The NPPES record for Clark Anderson was last updated on June 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.