Jonathan B. Clark, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Providence, RI
NPI 1275923781 · NPPES record last updated Sep 16, 2021
Key facts
- NPI
- 1275923781
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- APRN00302 (RI)
- Practice address
- 164 Summit Ave
Providence, RI 02906-2853 - Phone
- (401) 793-4575
- NPI assigned
- Feb 4, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2015
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Coastal Medical Associates
South Suburban Gastroenterology PC
Capa Anesthesia LLC
Practice addresses (Care Compare)
55 Fogg Rd
Weymouth, MA 02190-2432
Phone (781) 792-4136
97 Libbey Pkwy
Suite 300
Weymouth, MA 02189-3110
Phone (781) 331-2922
99 Libbey Industrial Park
Weymouth, MA 02189-3101
Phone (781) 331-0537
Hospital & facility affiliations
- South Shore Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.65 of 100
- Quality
- 88.12
- Promoting interoperability
- 71
- Improvement activities
- 40
- Cost
- 77.69
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150311001845 | MA | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 3476879313 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lawrence Anesthesia Services, LLC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Capa Anesthesia LLC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| South Suburban Gastroenterology, PC | Current |
Accepting new patients | |
| South Shore Anesthesia Associates, Inc | Past | Accepting new patients | |
| Weymouth Endoscopy, LLC | Past |
Accepting new patients | |
| Cap Anesthesia, PC | Past | Accepting new patients |
Locations
60 Hospital Rd
Leominster, MA 01453
Phone (978) 466-2000
40 Holland St
Somerville, MA 02144
Phone (617) 629-6000
55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293
97 Libbey Park
Ste 300
Weymouth, MA 02189
Phone (781) 331-2922
1085 Main St
Weymouth, MA 02190
Phone (781) 331-2922
123 Summer St
Worcester, MA 01608
Phone (508) 363-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN277232 | MA | |
| Certified Registered Nurse Anesthetist | 367500000X | APRN00302 | RI | Yes |
Addresses
Primary practice location
164 Summit Ave
Providence, RI 02906-2853
Mailing address
333 Ricciuti Dr
Apt. 1824
Quincy, MA 02169-6287
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110106160A | Medicaid | MA |
Other providers in Providence, RI
- Lindsay Erin Clark Donat
- Melanie Beth Clark-Medyesy
- Aimee Elizabeth Clark
- Clara Clark
- Jevin Clark
- Kerry A Clark
- Kristen M Clark
- Madelyn Isabel Clark
- Michael Clark
- Seth Clark
All providers in Providence, RI · Certified Registered Nurse Anesthetist in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.