Individual provider Active NPI

Bryan David Clements II, DO, MA

  • Neurology Physician
  • Chicago, IL
National Provider Identifier
1104454396
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036.174488 Issued in IL
Practice address
1725 W Harrison St Ste 309
Chicago, IL 60612-3844
Phone
(312) 942-8011
NPI assigned
Apr 1, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 036.174488 IL Primary

Addresses

Primary practice location

1725 W Harrison St Ste 309
Chicago, IL 60612-3844

Mailing address

1725 W Harrison St Ste 309
Chicago, IL 60612-3844
Phone (312) 942-8011

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241002003700 TX Order and Referring Only - NeurologyPractitioner - Neurology 4587195490

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Master of Arts

State licenses

LicenseStateTypeSpecialty
036.174488ILMDNeurology Physician

Interoperability endpoints

  • Direct secure messaging: bryan.clements.1@8363.direct.athenahealth.com

NPI Registry JSON

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

{
    "created_epoch": "1585699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1104454396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 W HARRISON ST STE 309",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123844",
            "telephone_number": "312-942-8011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 W HARRISON ST STE 309",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123844",
            "telephone_number": "312-942-8011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENTS",
        "first_name": "BRYAN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DO, MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-01",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036.174488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.