Active NPI
Sadikie Clarke
- Certified Registered Nurse Anesthetist
- Bronx, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 209031872
- Practice address
- 1065 Southern Blvd
Bronx, NY 10459-2417 - Phone
- (718) 589-2440
- Fax
- (718) 991-4516
- NPI assigned
- Jun 14, 2018
- Sex
- Male
- Sole proprietor
- No
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 | 209031872 | IL | Primary |
| Family Nurse Practitioner | 363LF0000X | 041581166 | IL |
Addresses
Primary practice location
1065 Southern Blvd
Bronx, NY 10459-2417
Mailing address
1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
500 John Deere Rd
Moline, IL 61265-6892
Phone (844) 937-1810
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 343634 | NY | MD | Licensed Practical Nurse |
| 041581166 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Osf Multi-Specialty Group | Current | Accepting new patients | |
| Clinical Colleagues Inc | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Clinical Colleagues Inc | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
695 N Kellogg St
Galesburg, IL 61401
Phone (309) 343-8131
3333 N Seminary St
Galesburg, IL 61401
Phone (309) 344-3161
500 John Deere Rd
Moline, IL 61265
Phone (309) 779-2840
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
2701 17th St
Rock Island, IL 61201
Phone (309) 779-3200
1 Stiles Rd
Ste 301
Salem, NH 03079
Organizations & group practices 4
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
- Galesburg, IL
- NPI 1316399967
Nurse Anesthetist, Certified Registered
-
- Internal Medicine Physician
- Peoria, IL
- NPI 1922445527
-
- Community/Retail Pharmacy
- Patton, PA
- NPI 1578541413
-
- Anesthesiology Physician
- Van Wert, OH
- NPI 1992725766
Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Rock Island, IL
- NPI 1316047632
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757376000000",
"number": "1306339247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1065 SOUTHERN BLVD",
"city": "BRONX",
"state": "NY",
"postal_code": "104592417",
"telephone_number": "718-589-2440",
"fax_number": "718-991-4516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1065 SOUTHERN BLVD",
"city": "BRONX",
"state": "NY",
"postal_code": "104592417",
"telephone_number": "718-589-2440",
"fax_number": "718-991-4516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "SADIKIE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-14",
"last_updated": "2025-09-09",
"certification_date": "2025-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IL",
"license": "209031872",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "041581166",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.