Ryan Patrick Clark, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085005075 Issued in IL

Practice address

309 W Saint Louis St
West Frankfort, IL 62896-2099

Phone

(618) 932-2200

NPI assigned

Apr 2, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sound Physicians of Illinois LLCGroup PAC ID 1557533734, 193 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM St Joseph Hospital West Hospital, Lake Saint Louis, MO, CCN 260200
• SSM St Joseph Health Center Hospital, Saint Charles, MO, CCN 260005
• SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104
• Mercy Hospital Lincoln Hospital, Troy, MO, CCN 261319

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: rclark22198@direct-ehr-ssmhc.com
• Direct secure messaging: rclark@yourcarecommunity.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sound Physicians of Illinois, LLC

  • Hospitalist Physician
  • Bridgeton, MO
  • NPI 1043598865
  Medicare reassignment Care Compare group
• Cogent Healthcare of Missouri, Inc

  • Critical Care Medicine (Internal Medicine) Physician
  • Fenton, MO
  • NPI 1780961599
  Medicare reassignment
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441

  MO

  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Hospital Lincoln

  • Critical Access Hospital
  • Troy, MO
  • NPI 1962808733
  Care Compare affiliation
• SSM Health Care St. Louis

  dba SSM Health St. Joseph Hospital - St. Charles

  • General Acute Care Hospital
  • Saint Charles, MO
  • NPI 1467521146
  Care Compare affiliation
• SSM Health Care St. Louis

  dba SSM Health DePaul Hospital - St. Louis

  • General Acute Care Hospital
  • Bridgeton, MO
  • NPI 1598835308
  Care Compare affiliation
• SSM Health Care St. Louis

  dba SSM Health St Joseph Hospital - Lake Saint Louis

  • General Acute Care Hospital
  • Lake St Louis, MO
  • NPI 1871665380
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408147200000",
    "number": "1013335496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 HOUSTON ST",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633011620",
            "telephone_number": "636-293-2038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 W SAINT LOUIS ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628962099",
            "telephone_number": "618-932-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RYAN",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2014-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085005075",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2014009216",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Centerstone of Illinois, Inc
• Madeline Charles, BA
• Yihnan Chiou, MD
• City of West Frankfort (West Frankfort Fire Department)
• Clark a Dixon DMD PC
• Alicia Clifton
• Robin Coble
• Crystal Coleman
• Jennifer Coleman, BS
• Reighan Corwin Coley, BS

• Medical Physician Assistant in West Frankfort, IL
• Providers in West Frankfort, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.