NPIMap

Individual provider Active NPI

Dennis J Clark, PA-C

  • Physician Assistant
  • State College, PA
National Provider Identifier
1689863805
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA052887 Issued in PA
Practice address
143 Hospital Dr Ste 112a
State College, PA 16803-5500
Phone
(814) 865-3566
Fax
(814) 863-7803
NPI assigned
Oct 24, 2007
Last updated
Sep 15, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA052887 PA Primary

Addresses

Primary practice location

143 Hospital Dr Ste 112a
State College, PA 16803-5500

Mailing address

1850 E Park Ave
Suite 112
State College, PA 16803-6705
Phone (814) 865-3566

Other identifiers 1

IdentifierTypeStateIssuer
MA052887OtherPALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071231000081 PA Practitioner - Physician Assistant 3274613492 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dubois Regional Medical CenterGroup PAC ID 5890689715, 424 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 371-2200

143 Hospital Dr
State College, PA 16803-3200
Phone (814) 235-2480

143 Hospital Dr
Suite 112
State College, PA 16803-6705
Phone (814) 865-3566

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

3100 Schoolhouse Rd
Middletown, PA 17057-3548
Phone (717) 948-5180

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.36 of 100Reported as group
Quality
56.69
Promoting interoperability
100
Improvement activities
40
Cost
74.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Milton S Hershey Medical Center Physician Group CurrentSince Jun 1, 2015 Accepting new patients
Dubois Regional Medical Center CurrentSince Oct 13, 2025 Accepting new patients
J C Blair Memorial Hospital CurrentSince Oct 13, 2025 Accepting new patients
The Milton S Hershey Medical Center Physicians Group CurrentSince Jun 1, 2015 Accepting new patients
J C Blair Memorial Hospital CurrentSince Oct 13, 2025 Accepting new patients
Dubois Regional Medical Center CurrentSince Oct 13, 2025 Accepting new patients
Clearfield Hospital Past Accepting new patients
Clearfield Hospital Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients

Locations

809 Turnpike Ave
Clearfield, PA 16830
Phone (814) 765-5341

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

100 Hospital Ave
Ofc
Dubois, PA 15801

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

1225 Warm Springs Ave
Huntingdon, PA 16652
Phone (814) 643-8206

3100 Schoolhouse Rd
Middletown, PA 17057
Phone (717) 948-5180

Organizations & group practices 9

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.

Hospital & facility affiliations 5

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": "1193184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1689863805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 E PARK AVE",
            "address_2": "SUITE 112",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036705",
            "telephone_number": "814-865-3566",
            "fax_number": "814-863-7803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 HOSPITAL DR STE 112A",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168035500",
            "telephone_number": "814-865-3566",
            "fax_number": "814-863-7803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DENNIS",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-24",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA052887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MA052887",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.