Clark Kellogg

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

32698321 Issued in OH

Practice address

799 Lexington Ave
Mansfield, OH 44907-1906

Phone

(419) 756-5133

Fax

(419) 774-9707

NPI assigned

May 16, 2022

Sex

Male

Sole proprietor

Yes

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 OH

Enrollment records 1

Specialty

Anesthesiology Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesia Associates of Mansfield, IncGroup PAC ID 3870486624, 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohiohealth Mansfield Hospital Hospital, Mansfield, OH, CCN 360118

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Anesthesia Associates of Mansfield, Inc

  • Anesthesiology Physician
  • Mansfield, OH
  • NPI 1407947815
  Medicare reassignment Care Compare group NPD

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

• Medcentral Health System

  • General Acute Care Hospital
  • Mansfield, OH
  • NPI 1790837235
  Care Compare affiliation
• Medcentral Health System

  • Clinical Medical Laboratory
  • Mansfield, OH
  • NPI 1962888016

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1457098154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5910 BLUESTONE WAY",
            "city": "LEWIS CENTER",
            "state": "OH",
            "postal_code": "430357550",
            "telephone_number": "614-301-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 LEXINGTON AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449071906",
            "telephone_number": "419-756-5133",
            "fax_number": "419-774-9707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLOGG",
        "first_name": "CLARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-16",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "OH",
            "license": "32698321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Keller
• Emily N Keller, PA-C
• Danielle Kelley, BS, MAE, EDD
• Rachael Kelley
• Robert Henry Kelley III
• Zanaireah Kelly Davis
• Courtney Kelly
• Kathryn Kelly, L.AC.
• Rebecca Kelly, CDCA
• Linda Kelso

• Anesthesiologist Assistant in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Anesthesiologist Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.