Active NPI
Jason Clark, CRNA
- Certified Registered Nurse Anesthetist
- Detroit, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4704237361
- Practice address
- 3990 John R St
Detroit, MI 48201-2018 - Phone
- (952) 442-9770
- NPI assigned
- Apr 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 4704237361 | MI | Primary |
Addresses
Primary practice location
3990 John R St
Detroit, MI 48201-2018
Mailing address
PO Box 67000
Dept 203401
Detroit, MI 48267-2034
Phone (952) 442-9770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI, IL
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1 Hurley PLZ
Flint, MI 48503-5902
Phone (810) 262-9353
1423 Chicago Rd
Chicago Heights, IL 60411-3400
Phone (708) 756-1000
201 S 14TH St
Herrin, IL 62948-3631
Phone (618) 942-2171
900 Peeler St
Kalamazoo, MI 49008-2300
Phone (269) 345-8618
Hospital & facility affiliations
- Bronson Methodist Hospital
- Hurley Medical Center
- Herrin Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.4 of 100
- Quality
- 66.97
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.88
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704237361 | MI | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PSJ Anesthesia PC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Resource Anesthesiology Associates of Mi PC | Current | Accepting new patients | |
| Hurley Medical Center | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Hurley Medical Center | Current | Accepting new patients | |
| Kalamazoo Anesthesiology P C | Current | Accepting new patients | |
| Michigan Crnas Staffing LLC | Past | Accepting new patients | |
| Northstar Anesthesia of Michigan II PC | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Locations
30400 Telegraph Rd
Ste 405
Bingham Farms, MI 48025
Phone (248) 483-8138
1 Hurley Plz
Flint, MI 48503
Phone (810) 257-9000
6245 Inkster Rd
Garden City, MI 48135
Phone (734) 421-3300
900 Peeler St
Kalamazoo, MI 49008
Phone (269) 345-8618
1707 Lake Lansing Rd
Lansing, MI 48912
Phone (517) 267-0033
826 W King St
Owosso, MI 48867
Phone (989) 720-2273
16001 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 424-3000
200 Hemlock St
Tawas City, MI 48763
Phone (989) 362-0153
Organizations & group practices 8
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.
-
- Certified Registered Nurse Anesthetist
- Flint, MI
- NPI 1558397653
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Kalamazoo, MI
- NPI 1407821796
-
- Certified Registered Nurse Anesthetist
- Southfield, MI
- NPI 1275905796
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Saginaw, MI
- NPI 1568755882
-
- Plastic and Reconstructive Surgery Physician
- Flint, MI
- NPI 1689345761
-
- Anesthesiology Physician
- Novi, MI
- NPI 1851666424
-
- Anesthesiology Physician
- Irving, TX
- NPI 1437268026
Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Kalamazoo, MI
- NPI 1831116441
-
- General Acute Care Hospital
- Flint, MI
- NPI 1598717480
-
- General Acute Care Hospital
- Herrin, IL
- NPI 1528158573
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821215047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 67000",
"address_2": "DEPT 203401",
"city": "DETROIT",
"state": "MI",
"postal_code": "482672034",
"telephone_number": "952-442-9770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3990 JOHN R ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012018",
"telephone_number": "952-442-9770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JASON",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MI",
"license": "4704237361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.