Benjamin Jacob Clark, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

28193318A Issued in IN

Practice address

600 East Blvd
Elkhart, IN 46514-2483

Phone

(574) 523-3193

NPI assigned

Dec 22, 2010

Last updated

Dec 22, 2010By 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 WA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Albany Medical College of Union University, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Apex Spine InstituteGroup PAC ID 3779979125, shared by 3 NPIs, 10 clinicians

Practice addresses (Care Compare)

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.

• Premier Anesthesia of Richland a Division of Premier Anesthesia, LLC

  dba Premier Anesthesia of Richland

  • Anesthesiology Physician
  • Richland, WA
  • NPI 1013940253

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Apex Spine Institute

  • Orthopaedic Surgery of the Spine Physician
  • Richland, WA
  • NPI 1154081446
  NPD (past)
• Premier Anesthesia of Florida LLC

  • Anesthesiology Physician
  • Bradenton, FL
  • NPI 1790330694

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1292976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292976000000",
    "number": "1407150055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14660 CARRIGAN CT",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465304222",
            "telephone_number": "574-523-3193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 EAST BLVD",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142483",
            "telephone_number": "574-523-3193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BENJAMIN",
        "middle_name": "JACOB",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-22",
        "last_updated": "2010-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28193318A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Elkhart
• City of Elkhart
• City Optical Co., Inc. (Dr Tavel Family Eye Care)
• Elizabeth Ciupinski
• Meghan Clairday
• Jessica Clark, MA
• Theresa Ann Clark, FNP-BC
• Makayla Clawson
• Seth Michael Claxton, CRNA
• David Clayton

• Certified Registered Nurse Anesthetist in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Certified Registered Nurse Anesthetist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2010; 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.