Richard D Clark, RN ARNP CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

09.006191 Issued in IL

Practice address

18221 Torrence Ave
Lansing, IL 60438-2870

Phone

(708) 895-9450

NPI assigned

Nov 30, 2005

Last updated

May 21, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 14

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, 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.

• Ambulatory Anesthesiologists of Chicago, LLC

  • Anesthesiology Physician
  • Chicago, IL
  • NPI 1659306272
  Medicare reassignment NPD
• Illinois Gastroenterology Group, LLC

  • Gastroenterology Physician
  • Elgin, IL
  • NPI 1316277817
  Medicare reassignment NPD
• Elgin Gastroenterology Endoscopy Center LLC

  dba The Endo Center of Elgin Gastroenterology

  • Ambulatory Surgical Clinic/Center
  • Elgin, IL
  • NPI 1992875454
  NPD
• Elgin Gastroenterology SC

  • Gastroenterology Physician
  • Elgin, IL
  • NPI 1932291101
  NPD
• Northwest Gastroenterologists SC

  • Specialist
  • Arlington Heights, IL
  • NPI 1801886221
  NPD
• Anesthesia Associates, LTD

  • Pain Medicine (Anesthesiology) Physician
  • Aurora, IL
  • NPI 1952308223
  NPD (past)
• Interventional Pain Management, LTD.

  • Pain Medicine (Anesthesiology) Physician
  • Lansing, IL
  • NPI 1891726345
  NPD (past)
• Valley Pain Care Centers LTD

  • Pain Medicine Physician
  • Dekalb, IL
  • NPI 1194722058
  NPD (past)
• Anesthesiology, Chartered

  • Certified Registered Nurse Anesthetist
  • Kansas City, KS
  • NPI 1760439533

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Excel Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Leawood, KS
  • NPI 1366559130

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Johnson County Anesthesiologists, Chartered

  • Anesthesiology Physician
  • Olathe, KS
  • NPI 1811940877

  Registered Nurse

  NPD (past)
• Leavenworth Anesthesia PA

  • Certified Registered Nurse Anesthetist
  • Leavenworth, KS
  • NPI 1679555262

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274400000000",
    "number": "1659355121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18221 TORRENCE AVE",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604382870",
            "telephone_number": "708-895-9408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18221 TORRENCE AVE",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604382870",
            "telephone_number": "708-895-9450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RICHARD",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "RN ARNP CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2010-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KS",
            "license": "1484659051",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "134677",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KS",
            "license": "54725",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "54725",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "134677",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "09.006191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KANSAS",
            "identifier": "161280",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "481192875",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00155221",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMIER HEALTH PLANS",
            "identifier": "P13178",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KANSAS CITY",
            "identifier": "27862039",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED HEALTH PROFESSI",
            "identifier": "27862039",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE BLUE",
            "identifier": "27862039",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "481192875",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "481192875",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "915697213",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "481192875",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "481192875",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KANSAS MEDICAL ASSISTISTA",
            "identifier": "100385650C",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY HEALTH PLAN",
            "identifier": "10001771600",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fritzgerald Charles
• Chiro One Wellness Center of Lansing SC
• Christian Community Health Center
• Elizabeth M Cichocki
• Circle of Trust Home Health Inc
• Matthew Clary, RPH
• CMH Travel & Transportation
• Adam Edward Cole, CRNA
• Cheryl Lee Cole, LCPC, LMFT
• Janine Coleman

• Certified Registered Nurse Anesthetist in Lansing, IL
• Providers in Lansing, IL by specialty
• Certified Registered Nurse Anesthetist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.