Clark Anderson, PA-C
Individual provider Active NPI Physician Assistant · Peoria, IL
NPI 1750460481 · NPPES record last updated Dec 10, 2014
Key facts
- NPI
- 1750460481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085-002809 (IL)
- Practice address
- 1001 Main St
Suite 500a
Peoria, IL 61606-1907 - Phone
- (309) 672-4980
- Fax
- (309) 671-2979
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 32
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Springfield Clinic, LLP
Mason Hospital District
Practice addresses (Care Compare)
1001 Main St
Suite 300
Peoria, IL 61606-2036
Phone (217) 528-7541
615 N Promenade St
Havana, IL 62644-1243
Phone (309) 543-8510
775 Engineering Ave
Springfield, IL 62703-5909
Phone (217) 522-4300
Hospital & facility affiliations
- Memorial Medical Center
- Saint Francis Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.83 of 100
- Quality
- 75.65
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.21 of 100
- Quality
- 67.65
- Promoting interoperability
- 99
- Improvement activities
- 40
- Cost
- 80.55
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071001000068 | IL | Practitioner - Physician Assistant | 8628163011 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-002809 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Methodist Medical Center of Illinois | Current |
Accepting new patients | |
| Springfield Clinic, LLP | Current |
Accepting new patients | |
| Methodist Medical Center of Illinois | Current |
Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
615 N Promenade St
Havana, IL 62644
Phone (309) 543-8510
112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402
8914 N Knoxville Ave
Peoria, IL 61615
Phone (309) 691-9110
1001 Main St
Ste 300
Peoria, IL 61606
Phone (309) 495-0200
1001 Main St
Ste 500A
Peoria, IL 61606
Phone (309) 672-4980
815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986
775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300
Interoperability endpoints
- clark.anderson.1@28977.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085-002809 | IL | Yes |
Addresses
Primary practice location
1001 Main St
Suite 500a
Peoria, IL 61606-1907
Mailing address
PO Box 365
Morton, IL 61550-0365
Phone (309) 672-4980
Other providers in Peoria, IL
- Jeremiah S. Anders
- Megan Emily Andersen
- Amy Anderson
- Bryan Anderson
- Christina Anderson
- Dean Anderson
- Debra Sue Anderson
- Donald R. Anderson
- Faith Anderson
- Gary Anderson
All providers in Peoria, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.