Todd V Clark, MD is a medicare enrolled "Dermatology" physician in Nicholasville, Kentucky. His current practice location is
249 E Brannon Rd, Nicholasville, Kentucky. You can reach out to his office (for appointments etc.) via phone at
(859) 354-5455.
Todd V Clark is licensed to practice in Kentucky (license number 42806) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1205078664.
Physician's Profile
| Full Name | Todd V Clark |
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| Gender | Male |
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| Speciality | Dermatology |
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| Location | 249 E Brannon Rd, Nicholasville, Kentucky |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1205078664
- Provider Enumeration Date: 04/01/2009
- Last Update Date: 07/10/2025
Medicare PECOS Information:
- PECOS PAC ID: 1456404011
- Enrollment ID: I20221114001986
Medical Identifiers
Medical identifiers for Todd V Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1205078664 | NPI | - | NPPES |
| 000000612211 | Other | | ANTHEM BLUE CROSS & BLUE SHIELD |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207N00000X | Dermatology | 42806 (Kentucky) | Primary |
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. Todd V Clark allows following entities to bill medicare on his behalf.
| Entity Name | Central Kentucky Dermatology Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1124741780
PECOS PAC ID: 2860869351
Enrollment ID: O20221114001903 |
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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. Todd V 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 |
|---|
Todd V Clark, MD
249 E Brannon Rd,
Nicholasville, KY 40356-8059
Ph: (859) 354-5455 | Todd V Clark, MD
249 E Brannon Rd,
Nicholasville, KY 40356-8059
Ph: (859) 354-5455 |
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