Individual provider Active NPI

Sadikie Clarke

  • Certified Registered Nurse Anesthetist
  • Bronx, NY
National Provider Identifier
1306339247
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209031872 Issued in IL
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

Updated by the provider on Sep 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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 IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250708002521 IL Practitioner - Anesthesiology 0143555342 Reassigns benefits to 1 organization
I20250805001684 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 0143555342 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices
Clinical Colleagues IncGroup PAC ID 8729011333, 170 clinicians

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

LicenseStateTypeSpecialty
343634NYMDLicensed Practical Nurse
041581166ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 22, 2025 Accepting new patients
Clinical Colleagues Inc Nurse Anesthetist, Certified Registered CurrentSince May 5, 2025 Accepting new patients
Clinical Colleagues Inc Nurse Anesthetist, Certified Registered CurrentSince May 5, 2025 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.

Hospital & facility affiliations 1

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

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

Verify at the official NPI Registry.