SAMUEL J. CLARK, M.D., INC.
NPI 1124079793
Internal Medicine - Pulmonary Disease in San Diego, CA

Q: What is Samuel J. Clark, M.D., Inc.'s NPI number?

The NPI number for Samuel J. Clark, M.D., Inc. is 1124079793. It was assigned to this organization in the NPPES registry on May 16, 2006.

Q: What is Samuel J. Clark, M.D., Inc.'s specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Active since May 16, 2006

1940 EL CAJON BLVD, SAN DIEGO, CA 92104(619) 218-5688(619) 795-3991 Get Directions Write a Review

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

Record update history: Jun 25, 2024, Aug 22, 2020 (2 updates tracked since 2020).

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About Samuel J. Clark, M.d., Inc. NPPES

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

SAMUEL J. CLARK, M.D., INC. (NPI 1124079793) is a healthcare organization registered as a pulmonary disease in San Diego, California and active in the NPI registry since May 2006. The organization lists Samuel J. Clark, President, as its authorized official.

NPPES Registry Identity

NPI1124079793

Entity TypeOrganization

Primary Taxonomy207RP1001X

Legal Business NameSAMUEL J. CLARK, M.D., INC.

Location Address1940 EL CAJON BLVDSan Diego, CA 92104-1005

Mailing AddressPo Box 881609San Diego, CA 92168-1609 · (619) 794-2521 · Fax (619) 794-2523

Phone(619) 218-5688

Fax(619) 795-3991

Organization SubpartNo

Authorized OfficialSamuel J. ClarkPresident · (619) 218-5688

Enumeration DateMay 16, 2006

Last NPPES UpdateJune 25, 20242 updates tracked since enumeration

NPPES CertifiedJune 25, 2024

✔ NPI 1124079793 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RP1001X

Definition

An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

1940 EL CAJON BLVD, San Diego, CA 92104

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel J. Clark, M.d., Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 4 clinicians reassign Medicare billing to Samuel J. Clark, M.D., Inc., which bills Medicare for the services they deliver. Of these, 1 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Samuel Clark, M.D.

Pulmonary Disease

NPI 1689611709

1940 EL CAJON BLVD
San Diego, CA 92104

(619) 543-4500

✔ PECOS✔ Accepts MedicareSame address

Soud Sediqe, M.D.

Pulmonary Disease

NPI 1366820540

8008 FROST ST STE 401
San Diego, CA 92123

(858) 309-5931

✔ PECOS3.1 mi

David Willms, M.D.

Pulmonary Disease

NPI 1285626747

7910 FROST STREET SUITE 245
San Diego, CA 92123

(858) 650-5037

✔ PECOS3.1 mi

Davies Wong, M.D.

Pulmonary Disease

NPI 1841282407

7910 FROST STREET SUITE 245
San Diego, CA 92123

(858) 650-5037

✔ PECOS✔ Accepts Medicare3.1 mi

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

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 Samuel J. Clark, M.D., Inc.'s NPI number?

The NPI number for Samuel J. Clark, M.D., Inc. is 1124079793. It was assigned to this organization in the NPPES registry on May 16, 2006.

Where is Samuel J. Clark, M.D., Inc. located?

Samuel J. Clark, M.D., Inc. is located at 1940 El Cajon Blvd, San Diego, CA 92104. The listed phone number is (619) 218-5688.

What is Samuel J. Clark, M.D., Inc.'s specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Is Samuel J. Clark, M.D., Inc. enrolled in Medicare?

Yes. Samuel J. Clark, M.D., Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Samuel J. Clark, M.D., Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Pulmonary Disease, reassign their Medicare billing to Samuel J. Clark, M.D., Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Samuel J. Clark, M.D., Inc. 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.