Ryan Mathew Clark, CRNA

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

2011022952 Issued in MO

Practice address

1500 N Oakland
Bolivar, MO 65613-3099

Phone

(417) 328-7705

NPI assigned

Aug 4, 2011

Last updated

Aug 4, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in MO

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Citizens Memorial Hospital DistrictGroup PAC ID 2769574433, 50 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Citizens Memorial Hospital Hospital, Bolivar, MO, CCN 260195

Merit-based Incentive Payment System (MIPS)

Final score

94.89 of 100Reported as group

Quality

100

Promoting interoperability

94

Improvement activities

40

Cost

85.3

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Citizens Memorial Hospital District

  • Emergency Medicine Physician
  • Bolivar, MO
  • NPI 1558548818
  Medicare reassignment Care Compare group NPD
• Citizens Memorial Hospital District

  dba CMH Buffalo Community Pharmacy

  • Community/Retail Pharmacy
  • Buffalo, MO
  • NPI 1427480995
  NPD

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

• Citizens Memorial Hospital District

  dba Citizens Memorial Hospital

  • General Acute Care Hospital
  • Bolivar, MO
  • NPI 1003981549
  Care Compare affiliation

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312416000000",
    "number": "1184903460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133099",
            "telephone_number": "417-328-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133099",
            "telephone_number": "417-328-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RYAN",
        "middle_name": "MATHEW",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-04",
        "last_updated": "2011-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "MO",
            "license": "2011022952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Citizens Memorial Hospital District (Stephens Pharmacy at CMH)
• Citizens Memorial Hospital District (CMH Dialysis Center)
• Citizens Memorial Hospital District
• Citizens Memorial Hospital District (CMH Portable Mobile Xray)
• Rachel Lynn Clark, CPHT
• CMH Foot and Ankle Clinic
• CMH Institute for Pain Management
• David Coalter
• Robert L Coffman, PSYD
• Jennifer Cole, PSYD

• Anesthesiologist Assistant in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Anesthesiologist Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; 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.

Verify at the official NPI Registry.