MR. DAVID BURTON JR. CLARK (LSW) – Social Worker, NPI 1164071338

MR. DAVID BURTON JR. CLARK (LSW) is a healthcare provider. based in Toledo, Ohio. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials LSW. The NPI Number for MR. DAVID BURTON JR. CLARK (LSW) is 1164071338

Main info

Male
8 Years Of Experience
Accepts Medicare Assignment
Name
MR. DAVID BURTON JR. CLARK (LSW)
NPI
1164071338
Phone
Not provided
Address
3170 W CENTRAL AVE STE B
Enumeration Date
10 September 2019
Last Update Date
10 September 2019

Doctor Profile

Medical School Name
UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE
Secondary Phone
-
Graduation Year
2018 (8 years ago)
PAC ID
2163934100
Group Practice PAC ID
9032422860
Professional Enrollment ID
I20251104000591
Address ID
OH436052397TO732XXSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience17
Completeness75
Years active:6State licenses:0Digital endpointsOther names

2,650 CLINICAL SOCIAL WORKER in OH

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Provider Addresses for MR. DAVID BURTON JR. CLARK (LSW)

  • West Central Avenue, Cumberland Street Historic District, Toledo, Lucas County, Ohio, 43610, United States

    TOLEDO, OH 436062945

    Phone:

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-11-04

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20251104000591IClinical Social WorkerOHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 43606)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9032422860View full group profile
NameSpecialtyState
Nurse PractitionerOH
Clinical Social WorkerOH
Nurse PractitionerOH
Clinical Social WorkerOH
Nurse PractitionerAL
Nurse PractitionerOH
Mental Health CounselorOH

Reviews

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Frequently asked questions

Can I cross-check MR. DAVID BURTON JR. CLARK (LSW) using NPI 1164071338?
NPI 1164071338 belongs to MR. DAVID BURTON JR. CLARK (LSW); compare other details if you need extra assurance.
Would MR. DAVID BURTON JR. CLARK (LSW) appear as active to a payer?
You can treat MR. DAVID BURTON JR. CLARK (LSW) as active for directory purposes; confirm clinical privileges separately.
How would a patient describe MR. DAVID BURTON JR. CLARK (LSW)'s focus?
For MR. DAVID BURTON JR. CLARK (LSW), the primary taxonomy reads as Social Worker. Clinical services aligned with this taxonomy classification.
Where in Ohio is MR. DAVID BURTON JR. CLARK (LSW) registered?
Use Toledo, Ohio as the headline location for MR. DAVID BURTON JR. CLARK (LSW) here.
When was this NPI issued?
Enumeration for MR. DAVID BURTON JR. CLARK (LSW) is noted as September 10, 2019 where the registry provides it.

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