John Riley Clark, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085.007136 Issued in IL

Practice address

2700 Light Rd Apt 102
Oswego, IL 60543-9231

Phone

(415) 516-8668

NPI assigned

Jun 13, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564704000000",
    "number": "1063072973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 LIGHT RD APT 102",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605439231",
            "telephone_number": "415-516-8668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 LIGHT RD APT 102",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605439231",
            "telephone_number": "415-516-8668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOHN",
        "middle_name": "RILEY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-13",
        "last_updated": "2019-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.007136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen J. Chorvat, MD
• Ryan Christiano
• Sharon Christy, M.D.
• Catherine Chu, M.D.
• David Allen Cinto, DDS
• Steven S Clay
• Stephanie Coccaro
• Jason Scott Cole, LCPC, CADC
• Community Alliance Home Health
• Community Alliance Home Health

• Medical Physician Assistant in Oswego, IL
• Providers in Oswego, 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 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.