Individual provider Active NPI

Jason Clark, CRNA

  • Certified Registered Nurse Anesthetist
  • Detroit, MI
National Provider Identifier
1821215047
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704237361 Issued in MI
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

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070714000024 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 3678673076 Reassigns benefits to 4 organizations
I20260519000714 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3678673076 Reassigns benefits to 1 organization

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
Hurley Medical CenterGroup PAC ID 2961308481, 336 clinicians
Northstar Anesthesia of Illinois, LLCGroup PAC ID 4688893878, 404 clinicians
Kalamazoo Anesthesiology P CGroup PAC ID 3375449473, 135 clinicians

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 Hospital, Kalamazoo, MI, CCN 230017
  • Hurley Medical Center Hospital, Flint, MI, CCN 230132
  • Herrin Hospital Hospital, Herrin, IL, CCN 140011

Merit-based Incentive Payment System (MIPS)

Final score
92.4 of 100Reported as group
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

LicenseStateTypeSpecialty
4704237361MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
PSJ Anesthesia PC Nurse Anesthetist, Certified Registered CurrentSince Oct 10, 2016 Accepting new patients
Resource Anesthesiology Associates of Mi PC CurrentSince Jun 13, 2019 Accepting new patients
Hurley Medical Center Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2020 Accepting new patients
Hurley Medical Center CurrentSince Jun 1, 2020 Accepting new patients
Kalamazoo Anesthesiology P C CurrentSince Mar 2, 2026 Accepting new patients
Michigan Crnas Staffing LLC PastSince Nov 12, 2012 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.

Hospital & facility affiliations 3

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": "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.

Verify at the official NPI Registry.