SHANE CHAMBERLAIN CLARK (M.D.) – Dermatology Physician, NPI 1548495336
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
607 DERMATOLOGY in OH
Provider Addresses for SHANE CHAMBERLAIN CLARK (M.D.)
347 W MILLTOWN RD STE B
WOOSTER, OH 446917216
Phone: (330) 345-1540
Fax: (330) 345-1541
Type: Mailing
Far Hills Avenue, Oakwood, Montgomery County, Ohio, 45469, United States
DAYTON, OH 454292347
Phone: (937) 433-7536
Fax: (937) 433-9612
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 71 Open Payments records for all available years, with a total value of $1,123.
Total Amount is formed as General ($1,123) + Research ($0) + Ownership ($0) = $1,123.
Last reported payment date: 2024-12-27 • Largest payer in this snapshot: Dermavant Sciences, Inc. ($298).
Total Amount
$1,123
General + Research + Ownership
Payments
71
Total payment records
General Amount
$1,123
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-27
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Dermavant Sciences, Inc. | $298 |
| Janssen Biotech, Inc. | $211 |
| Boehringer Ingelheim Pharmaceuticals, Inc. | $143 |
| GENZYME CORPORATION | $97 |
| LEO Pharma Inc. | $94 |
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: 2013-07-12
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20130712000591 | I | Dermatology | OH | TBD |
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.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 2,507 | 519 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1,123 | 813 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 889 | 713 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 613 | 510 | $0 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 544 | 104 | $0 |
Insurance plans in this area (ZIP 44691)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DERMATOLOGY | OH | 17003 | Destruction of 2-14 skin growths | 2552 | 430 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | IL | |
| - | OH | |
| Physician Assistant | OH | |
| Physician Assistant | OH | |
| D E R M A T O L O G Y | OH | |
| Physician Assistant | OH | |
| D E R M A T O L O G Y | OH | |
| D E R M A T O L O G Y | OH | |
| Physician Assistant | OH | |
| D E R M A T O L O G Y | OH |
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