RUSSELL DERRICK CLARK DPT
NPI 1639530686
Physical Therapist in Greenville, SC

Active since March 17, 2016Accepts Medicare Assignment
1011 GROVE RD STE 2A, GREENVILLE, SC 29605(864) 233-5128(864) 271-2599 Get Directions Write a Review

NPPES record last updated: March 17, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Russell Derrick Clark Dpt NPPES

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

RUSSELL DERRICK CLARK DPT (NPI 1639530686) is an individual physical therapist in Greenville, South Carolina, licensed in South Carolina (8087) and active in the NPI registry since March 2016. He is a graduate of Other (2015).

NPPES Registry Identity

NPI1639530686
Entity TypeIndividualMale
Primary Taxonomy225100000X
Provider Legal NameRUSSELL DERRICK CLARKCredential: DPT
Location Address1011 GROVE RD STE 2AGreenville, SC 29605-4660
Mailing Address1011 Grove Rd Ste 2aGreenville, SC 29605-4660 · (864) 233-5128 · Fax (864) 271-2599
Fax(864) 271-2599
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateMarch 17, 2016
NPI 1639530686 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225100000X
License Licensed in SC · 8087
Definition
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.
1011 GROVE RD STE 2A, Greenville, SC 29605

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

Russell Derrick Clark Dpt 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 ID5597055772
PECOS Enrollment IDI20250626000296

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29605 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
$83.18 typical visit price
range $53.57 – $163.84
Typical copayment $20.79 (range $13.39 – $40.96)
Most-billed visit code 99203
Established Patient
$67.12 typical visit price
range $16.96 – $133.52
Typical copayment $16.78 (range $4.24 – $33.38)
Most-billed visit code 99213
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 2

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

Physical Therapist
1011 GROVE RD STE 2A
GREENVILLE, SC 29605
Social Worker (Clinical)
1011 GROVE RD STE 2A
GREENVILLE, SC 29605

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 Russell Clark's NPI number?

The NPI number for Russell Clark is 1639530686. It was assigned to this individual provider in the NPPES registry on March 17, 2016.

Where is Russell Clark located?

Russell Clark practices at 1011 Grove Rd Ste 2A, Greenville, SC 29605. The listed phone number is (864) 233-5128.

What is Russell Clark's specialty?

The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.

Is Russell Clark enrolled in Medicare?

Yes. Russell Clark 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.

When was this NPI record last updated?

The NPPES record for Russell Clark was last updated on March 17, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.