Jonathan B. Clark, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

APRN00302 Issued in RI

Practice address

164 Summit Ave
Providence, RI 02906-2853

Phone

(401) 793-4575

NPI assigned

Feb 4, 2015

Last updated

Sep 16, 2021By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Group practices

Coastal Medical AssociatesGroup PAC ID 7113029257, 443 clinicians

South Suburban Gastroenterology PCGroup PAC ID 9931194412, 50 clinicians

Capa Anesthesia LLCGroup PAC ID 1850786393, 69 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• South Shore Hospital Hospital, South Weymouth, MA, CCN 220100

Merit-based Incentive Payment System (MIPS)

Final score

86.65 of 100Reported as group

Quality

88.12

Promoting interoperability

71

Improvement activities

40

Cost

77.69

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.

• Capa Anesthesia LLC

  • Anesthesiology Physician
  • Weymouth, MA
  • NPI 1629723002

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• South Suburban Gastroenterology, PC

  • Gastroenterology Physician
  • South Weymouth, MA
  • NPI 1114948478
  Medicare reassignment Care Compare group NPD
• Coastal Medical Associates

  • Anesthesiology Physician
  • Weymouth, MA
  • NPI 1932175684
  Medicare reassignment Care Compare group
• Lawrence Anesthesia Services, LLC

  • Anesthesiology Physician
  • Lawrence, MA
  • NPI 1467699918

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Cap Anesthesia, PC

  • Anesthesiology Physician
  • Weston, MA
  • NPI 1497763213
  NPD (past)
• South Shore Anesthesia Associates, Inc

  • Anesthesiology Physician
  • Weymouth, MA
  • NPI 1215066394
  NPD (past)
• Weymouth Endoscopy, LLC

  • Endoscopy Clinic/Center
  • South Weymouth, MA
  • NPI 1033199906
  NPD (past)

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

• South Shore Hospital Inc.

  • General Acute Care Hospital
  • South Weymouth, MA
  • NPI 1134227606
  Care Compare affiliation

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

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1275923781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 RICCIUTI DR",
            "address_2": "APT. 1824",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021696287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062853",
            "telephone_number": "401-793-4575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JONATHAN",
        "middle_name": "B.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-04",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "RN277232",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "RI",
            "license": "APRN00302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Erin Clark Donat, MD
• Melanie Beth Clark-Medyesy, M.S. CCC-SLP
• Aimee Elizabeth Clark
• Clara Clark
• Jevin Clark, MD
• Kerry A Clark, NP
• Kristen M Clark, NP
• Madelyn Isabel Clark
• Michael Clark, NP
• Seth Clark

• Certified Registered Nurse Anesthetist in Providence, RI
• Providers in Providence, RI by specialty
• Certified Registered Nurse Anesthetist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.