Kelly A Clark, C.R.N.A.

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

13943-NA Issued in OH

Practice address

5151 Reed Rd
Suite 225-C
Columbus, OH 43220-2595

Phone

(614) 457-2306

Fax

(614) 884-0776

NPI assigned

Aug 13, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Physician Anesthesia Services, Inc.Group PAC ID 8921997230, 159 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverside Methodist Hospital Hospital, Columbus, OH, CCN 360006
• Dublin Methodist Hospital Hospital, Dublin, OH, CCN 360348
• Grant Medical Center Hospital, Columbus, OH, CCN 360017

Merit-based Incentive Payment System (MIPS)

Final score

83 of 100Reported as group

Quality

80

Improvement activities

40

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.

• Midwest Physician Anesthesia Services, Inc.

  • Anesthesiology Physician
  • Columbus, OH
  • NPI 1598703951

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Anesthesia Group Practice, Inc

  • Anesthesiology Physician
  • Montgomery, OH
  • NPI 1417951948

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Deperro Plastic Surgery, LLC

  • Plastic Surgery Physician
  • Columbus, OH
  • NPI 1134573496
  NPD (past)

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

• Ohiohealth Corporation

  • General Acute Care Hospital
  • Columbus, OH
  • NPI 1255377149
  Care Compare affiliation
• Ohiohealth Corporation

  • General Acute Care Hospital
  • Columbus, OH
  • NPI 1467484972
  Care Compare affiliation
• Ohiohealth Corporation

  • Clinical Medical Laboratory
  • Columbus, OH
  • NPI 1710916945

  Hospital

  Care Compare affiliation
• Ohiohealth Corporation

  • General Acute Care Hospital
  • Dublin, OH
  • NPI 1801937008
  Care Compare affiliation

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432080000000",
    "number": "1760739494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5151 REED RD",
            "address_2": "SUITE 225-C",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432202595",
            "telephone_number": "614-457-2306",
            "fax_number": "614-884-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 REED RD",
            "address_2": "SUITE 225-C",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432202595",
            "telephone_number": "614-457-2306",
            "fax_number": "614-884-0776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "middle_name": "A",
        "credential": "C.R.N.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2015-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "13943-NA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COA",
            "identifier": "13943NA",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "RN217602",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0072751",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01187168",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joreece Clark
• Joshua Alan Clark, DDS
• Karen Clark
• Kathryn Elizabeth Clark
• Kaylee Clark
• Kenneth Morris Clark Jr.
• Laura Clark, PHARM.D
• Maria Clark, LPN
• Matthew Louis Clark, PHARMD
• Megan Elizabeth Hoppert Clark, OTR

• Certified Registered Nurse Anesthetist in Columbus, OH
• Providers in Columbus, OH by specialty
• Certified Registered Nurse Anesthetist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; 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.