NPIMap

Individual provider Active NPI

Jimmy Clark Jr., P.A. - C

  • Physician Assistant
  • Madison, WI
National Provider Identifier
1891164372
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3614 Issued in WI
Practice address
5512 Spring Tide Way
Madison, WI 53718-9125
Phone
(224) 848-0612
NPI assigned
Sep 15, 2015
Last updated
Jun 9, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

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 3614 WI Primary

Addresses

Primary practice location

5512 Spring Tide Way
Madison, WI 53718-9125

Mailing address

5512 Spring Tide Way
Madison, WI 53718-9125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20151028000000 WI Practitioner - Physician Assistant 4789993049 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stoughton Hospital AssociationGroup PAC ID 7012825706, 66 clinicians

Practice addresses (Care Compare)

5614 US Hwy 51
McFarland, WI 53558-8708
Phone (608) 838-8242

900 Ridge St
Stoughton, WI 53589-1864
Phone (608) 873-6611

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.19 of 100Reported as group
Quality
74.01
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
87.78
Promoting interoperability
77
Improvement activities
40
Cost
75.8

Merit-based Incentive Payment System (MIPS)

Final score
85.73 of 100Reported as group
Quality
87.42
Promoting interoperability
100
Improvement activities
40
Cost
65.02

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3614WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Reedsburg Area Medical Center Inc CurrentSince Mar 3, 2018 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Dec 14, 2015 Accepting new patients
Edgerton Hospital and Health Services Inc CurrentSince Oct 7, 2024 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Dec 14, 2015 Accepting new patients
Stoughton Hospital Association CurrentSince Nov 25, 2024 Accepting new patients
Reedsburg Area Medical Center, Inc. CurrentSince Mar 3, 2018 Accepting new patients
Edgerton Hospital and Health Services, Inc CurrentSince Oct 7, 2024 Accepting new patients

Locations

1969 W Hart Rd
Beloit, WI 53511
Phone (608) 364-5011

11101 N Sherman Rd
Edgerton, WI 53534
Phone (608) 884-1695

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

700 S Park St
Madison, WI 53715
Phone (608) 260-2900

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

831 Arthur Dr
Milton, WI 53563
Phone (608) 868-3526

2000 N Dewey Ave
Reedsburg, WI 53959
Phone (608) 524-6487

900 Ridge St
Stoughton, WI 53589
Phone (608) 231-3410

Interoperability endpoints

  • Direct secure messaging: jclark259160@direct-ehr-ssmhc.com

Organizations & group practices 12

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 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": "1442275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1891164372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5512 SPRING TIDE WAY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537189125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5512 SPRING TIDE WAY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537189125",
            "telephone_number": "224-848-0612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JIMMY",
        "name_suffix": "Jr.",
        "credential": "P.A. - C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-15",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.