Nathaniel Clark, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085003278 Issued in IL

Practice address

409 W Oak St
Carbondale, IL 62901-1464

Phone

(618) 529-4455

Fax

(618) 351-1287

NPI assigned

Sep 3, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 4

Medicare fee-for-service enrollment

Enrolled in IL

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Deaconess Illinois Specialty Clinic, Inc.Group PAC ID 9830562016, 145 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Heartland Regional Medical Center Hospital, Marion, IL, CCN 140184
• Herrin Hospital Hospital, Herrin, IL, CCN 140011
• Ferrell Hospital Community Foundations Hospital, Eldorado, IL, CCN 141324
• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164

Merit-based Incentive Payment System (MIPS)

Final score

77.51 of 100Reported as group

Quality

49.04

Promoting interoperability

95

Improvement activities

40

Cost

69.42

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nathaniel.clark.1@27782.direct.athenahealth.com
• Direct secure messaging: nclark422280@direct.deaconess.com
• Direct secure messaging: nclark01@yourcarecommunity.org

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

• Deaconess Illinois Specialty Clinic, Inc.

  • Surgery Physician
  • Marion, IL
  • NPI 1972210235
  Medicare reassignment Care Compare group
• Southern Illinois Medical Services, NFP

  • Internal Medicine Physician
  • Carbondale, IL
  • NPI 1770656837
  Medicare reassignment NPD
• Prairie Cardiovascular Consultants LTD

  • Multi-Specialty Clinic/Center
  • Springfield, IL
  • NPI 1982714218
  Medicare reassignment
• Deaconess Illinois Specialty Clinic, Inc.

  • Hospitalist Physician
  • Anna, IL
  • NPI 1225858251

  Physician Assistant

  NPD
• Deaconess Illinois Specialty Clinic, Inc.

  • Emergency Medicine Physician
  • Marion, IL
  • NPI 1336845015
  NPD
• Deaconess Illinois Clinic, Inc

  • Family Medicine Physician
  • Mount Vernon, IL
  • NPI 1245956523
  NPD (past)
• Prairie Cardiovascular Consultants LTD

  • Cardiovascular Disease Physician
  • Springfield, IL
  • NPI 1659539559
  NPD (past)

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

• Central Dupage Hospital Association

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation
• Deaconess Regional Healthcare Services Illinois Inc

  • General Acute Care Hospital
  • Marion, IL
  • NPI 1750007266
  Care Compare affiliation
• Ferrell Hospital Community Foundation

  • Rural Health Clinic/Center
  • Carmi, IL
  • NPI 1134650997

  Hospital

  Care Compare affiliation
• Ferrell Hospital Community Foundation

  • Rural Health Clinic/Center
  • Harrisburg, IL
  • NPI 1184202392

  Hospital

  Care Compare affiliation
• Ferrell Hospital Community Foundation

  • Critical Access Hospital
  • Eldorado, IL
  • NPI 1194713404
  Care Compare affiliation
• Ferrell Hospital Community Foundation

  • Rural Health Clinic/Center
  • Eldorado, IL
  • NPI 1457586620

  Hospital

  Care Compare affiliation
• Ferrell Hospital Community Foundation

  • Rural Health Clinic/Center
  • MC Leansboro, IL
  • NPI 1689217820

  Hospital

  Care Compare affiliation
• Ferrell Hospital Community Foundation

  • Rural Health Clinic/Center
  • Eldorado, IL
  • NPI 1700011046

  Hospital

  Care Compare affiliation
• Southern Illinois Hospital Services

  • General Acute Care Hospital
  • Carbondale, IL
  • NPI 1093801797
  Care Compare affiliation
• Southern Illinois Hospital Services

  • General Acute Care Hospital
  • Herrin, IL
  • NPI 1528158573
  Care Compare affiliation

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1063660074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 W OAK ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011464",
            "telephone_number": "618-529-4555",
            "fax_number": "618-351-1287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 W OAK ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011464",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3905 W Ernestine Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "IL",
            "postal_code": "629595800",
            "country_code": "US",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Dr Warren Tuttle Dr",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "IL",
            "postal_code": "629462718",
            "country_code": "US",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "217 S Park Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483611",
            "country_code": "US",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NATHANIEL",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "085-003278",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00657126",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nclark15601@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "409 W Oak St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011464",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nclark15601@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "3905 W Ernestine Dr",
            "city": "Marion",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629595800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nclark15601@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "100 Dr Warren Tuttle Dr",
            "city": "Harrisburg",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629462718",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nclark15601@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "217 S Park Ave Ste 2",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629483611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kathryn Churling, M.D.
• Vadzim Chyzhyk, MD
• Bria Ciganovich, CRNA
• Dominic Cittadino, D.D.S.
• Cynthia Adrian Clark, PH.D.
• Sonya Clark, LCSW
• James Clement, M.D.
• Jennifer Lynn Clevenger, CRNA
• Clifford L Coleman & Associates LTD
• Clinic Laboratory

• Physician Assistant in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; 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.