Active NPI
Dylan Ross Clark, STUDENT
- Certified Registered Nurse Anesthetist
- Boston, MA
National Provider Identifier
1104530930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- RN2287470
- Practice address
- 1 Boston Medical Center Place
Boston, MA 02118 - Phone
- (617) 638-6950
- NPI assigned
- Jan 6, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN2287470 | MA | Primary |
| Registered Nurse | 163W00000X | RN2287470 | MA |
Addresses
Primary practice location
1 Boston Medical Center Place
Boston, MA 02118
Mailing address
960 Massachusetts Ave
FLR 2
Boston, MA 02118
Other practice location 1
140 Commonwealth Ave
Chestnut Hill, MA 02467-3858
Phone (617) 552-2756
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110224269A | Medicaid | MA | |
| 3150309 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 638-6950
Hospital & facility affiliations
- Boston Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boston Medical Center Corporation | Current | Accepting new patients | |
| Boston University Medical Center Anesthesiologists, Inc. | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
960 Massachusetts Ave
Ste 2
Boston, MA 02118
725 Albany St
#7C
Boston, MA 02118
Phone (617) 638-6950
1 Boston Medical Ctr Pl
Roxbury, MA 02118
Phone (617) 414-5245
Interoperability endpoints
- dclark236193@direct.bmc.masshiway.net
Organizations & group practices 2
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.
-
- Anesthesiology Physician
- Boston, MA
- NPI 1952874737
Nurse Anesthetist, Certified Registered
-
- General Acute Care Hospital
- Boston, MA
- NPI 1346218294
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Boston, MA
- NPI 1164177028
-
- Community Health Clinic/Center
- South Boston, MA
- NPI 1225228679
Hospital
-
- General Acute Care Hospital
- Boston, MA
- NPI 1346218294
-
- Community Health Clinic/Center
- Roslindale, MA
- NPI 1386718823
Hospital
-
- Community Health Clinic/Center
- Dorchester, MA
- NPI 1780874677
Hospital
-
- Community Health Clinic/Center
- East Boston, MA
- NPI 1861683518
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775088000000",
"number": "1104530930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "960 MASSACHUSETTS AVE",
"address_2": "FLR 2",
"city": "BOSTON",
"state": "MA",
"postal_code": "02118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOSTON MEDICAL CENTER PLACE",
"city": "BOSTON",
"state": "MA",
"postal_code": "02118",
"telephone_number": "617-638-6950"
}
],
"practiceLocations": [
{
"address_1": "140 Commonwealth Ave",
"address_purpose": "LOCATION",
"city": "Chestnut Hill",
"state": "MA",
"postal_code": "024673858",
"country_code": "US",
"telephone_number": "617-552-2756",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLARK",
"first_name": "DYLAN",
"middle_name": "ROSS",
"name_prefix": "Mr.",
"credential": "STUDENT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-06",
"last_updated": "2026-04-02",
"certification_date": "2026-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MA",
"license": "RN2287470",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MA",
"license": "RN2287470",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110224269A",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3150309",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.