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DR. GARY BRUCE CLARK MD
NPI 1902962939
General Practice in Boulder, CO

Active since December 27, 2006Opted out of Medicare · through Sep 24, 2027
1790 30TH ST, SUITE 230, BOULDER, CO 80301(303) 444-5131(303) 444-5131 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Gary Bruce Clark Md NPPES

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

DR. GARY BRUCE CLARK MD (NPI 1902962939) is an individual general practice provider in Boulder, Colorado, licensed in Colorado (20926) and active in the NPI registry since December 2006. He has opted out of Medicare through September 24, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1902962939
Entity TypeIndividualMale
Primary Taxonomy208D00000X
Provider Legal NameDR. GARY BRUCE CLARKCredential: MD
Location Address1790 30TH ST, SUITE 230Boulder, CO 80301-1022
Mailing Address12541 Grove StBroomfield, CO 80020-5869 · (720) 887-5726
Phone(303) 444-5131
Fax(303) 444-5131
Sole ProprietorYes
Enumeration DateDecember 27, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1902962939 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in CO · 20926
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
1790 30TH ST, Boulder, CO 80301
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Gary Bruce Clark Md has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 24, 2015 through September 24, 2027.

Opt-Out Effective DateSeptember 24, 2015
Opt-Out In Effect ThroughSeptember 24, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 16

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

DR. LISA M LUCIANO PHD
Counselor (Mental Health)
1790 30TH ST, SUITE 440
BOULDER, CO 80301
Boulder County (303) 442-3755
LINDA L. WILKINSON PH.D, LPC
Counselor (Professional)
1790 30TH ST, SUITE 302
BOULDER, CO 80301
Boulder County (303) 442-5545
MS. GUDRUN A DILGER MED, MA, LPC, CACIII
Counselor (Addiction (Substance Use Disorder))
1790 30TH ST, SUITE 245
BOULDER, CO 80301
Boulder County (303) 859-5778
BRIAN T. SHEA DO LLC
Internal Medicine
1790 30TH ST, SUITE 120
BOULDER, CO 80301
Boulder County (303) 447-0022
EMILY MUERY
Chiropractor
1790 30TH ST
BOULDER, CO 80301
Boulder County (720) 636-6064
HILARY BOOCO
Speech-Language Pathologist
1790 30TH ST, SUITE 120
BOULDER, CO 80301
Boulder County (303) 447-0022
RUTH WHARTON M.A., LPC
Counselor (Professional)
1790 30TH ST, SUITE 200
BOULDER, CO 80301
Boulder County (303) 494-1778
BOULDER THERAPEUTICS, INC.
Massage Therapist
1790 30TH ST, SUITE #200
BOULDER, CO 80301
Boulder County (303) 444-1171

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 Gary Clark's NPI number?

The NPI number for Gary Clark is 1902962939. It was assigned to this individual provider in the NPPES registry on December 27, 2006.

Where is Gary Clark located?

Gary Clark practices at 1790 30th St Suite 230, Boulder, CO 80301. The listed phone number is (303) 444-5131.

What is Gary Clark's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Gary Clark enrolled in Medicare?

No. Gary Clark has opted out of Medicare through September 24, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Gary Clark was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.