NPIMap

Individual provider Active NPI

Kevin Clarke, PA

  • Physician Assistant
  • Joliet, IL
National Provider Identifier
1063475432
Registry record updated Aug 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085001326 Issued in IL
Practice address
333 Madison St
Joliet, IL 60435-8200
Phone
(815) 725-7000
NPI assigned
Apr 7, 2006
Last updated
Aug 18, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085001326 IL Primary

Addresses

Primary practice location

333 Madison St
Joliet, IL 60435-8200

Mailing address

1200 Harger Rd Ste 408
Oak Brook, IL 60523-1818
Phone (630) 581-6522

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050405001065 IL Practitioner - Physician Assistant 2365499092 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians
Edward HospitalGroup PAC ID 0042108110, 98 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Evanston, IL 60201-1700

6701 US Hwy 34
Oswego, IL 60543-9129
Phone (630) 646-4255

801 S Washington St
Naperville, IL 60540-7430
Phone (312) 355-0450

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085001326ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Edward Hospital CurrentSince Aug 2, 2022 Accepting new patients
Cepamerica Illinois LLP CurrentSince Jan 1, 2012 Accepting new patients
Endeavor Health Medical Group CurrentSince Apr 18, 2024 Accepting new patients
Elmhurst Memorial Hospital CurrentSince Aug 2, 2022 Accepting new patients
Edward Health Ventures CurrentSince Jul 1, 2020 Accepting new patients
Cepamerica Illinois LLP CurrentSince Jan 1, 2012 Accepting new patients
Edward Hospital CurrentSince Aug 2, 2022 Accepting new patients
Edward Health Ventures CurrentSince Jul 1, 2020 Accepting new patients
Midwest Orthopaedic Center S C Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

303 W Lake St
Ste 301
Addison, IL 60101
Phone (331) 221-1650

600 S Randall Rd
Algonquin, IL 60102
Phone (224) 783-4300

9532 Eagle Way
Chicago, IL 60678

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

333 Madison St
Joliet, IL 60435
Phone (815) 725-7222

3033 Ogden Ave
Ste 101
Lisle, IL 60532
Phone (630) 646-6200

120 Spalding Dr
Ste 101
Naperville, IL 60540
Phone (630) 527-7730

120 Spalding Dr
Ste 310
Naperville, IL 60540
Phone (630) 527-5575

801 S Washington St
Naperville, IL 60540
Phone (312) 355-0450

6701 US Highway 34
Oswego, IL 60543
Phone (630) 646-4200

Interoperability endpoints

  • FHIR API: https://fhirprd.edward.org/fhirprd/api/FHIR/R4/

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1063475432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 HARGER RD STE 408",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231818",
            "telephone_number": "630-581-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 MADISON ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604358200",
            "telephone_number": "815-725-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "KEVIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-07",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085001326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.