Derek Blaine Clark, DO is a medicare enrolled "Family Medicine" physician in Parksley, Virginia. He went to Edward Via Col Of Osteo Medicine-virginia Campus and graduated in 2021 and has 5 years of diverse experience with area of expertise as Family Practice. He is a member of the group practice Riverside Physician Services Inc and his current practice location is
17385 Lankford Hwy, Parksley, Virginia. You can reach out to his office (for appointments etc.) via phone at
(757) 665-5996.
Derek Blaine Clark is licensed to practice in Virginia (license number 0102208196) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1568041655.
Physician's Profile
| Full Name | Derek Blaine Clark |
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| Gender | Male |
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| Speciality | Family Practice |
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| Experience | 5 Years |
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| Location | 17385 Lankford Hwy, Parksley, Virginia |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Derek Blaine Clark attended and graduated from Edward Via Col Of Osteo Medicine-virginia Campus in 2021
NPI Data:
- NPI Number: 1568041655
- Provider Enumeration Date: 04/06/2021
- Last Update Date: 11/04/2024
Medicare PECOS Information:
- PECOS PAC ID: 9931502366
- Enrollment ID: I20240930003689
Medical Identifiers
Medical identifiers for Derek Blaine Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1568041655 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 0102208196 (Virginia) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Riverside Physician Services Inc | 5092608448 | 713 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Derek Blaine Clark allows following entities to bill medicare on his behalf.
| Entity Name | Riverside Physician Services Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1194929026
PECOS PAC ID: 5092608448
Enrollment ID: O20040207000400 |
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| Entity Name | Peninsula Cancer Institute, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1710180120
PECOS PAC ID: 8729031638
Enrollment ID: O20050302000714 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Derek Blaine Clark is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Derek Blaine Clark, DO
856 J Clyde Morris Blvd Ste A,
Newport News, VA 23601-1318
Ph: (757) 316-5800 | Derek Blaine Clark, DO
17385 Lankford Hwy,
Parksley, VA 23421-3882
Ph: (757) 665-5996 |
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