Clifford Syner III, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4628 Issued in WI

Practice address

14555 W National Ave
New Berlin, WI 53151-4494

Phone

(262) 827-2955

Fax

(262) 827-2958

NPI assigned

Apr 22, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 26, 2026 through Jun 26, 2028

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Clarksville Sportsmed & Wellness

  • Sports Medicine (Family Medicine) Physician
  • Clarksville, TN
  • NPI 1588941942
  NPD (past)

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

{
    "created_epoch": "1271894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566345600000",
    "number": "1962729533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843",
            "telephone_number": "414-389-2338",
            "fax_number": "414-385-8987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14555 W NATIONAL AVE",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531514494",
            "telephone_number": "262-827-2955",
            "fax_number": "262-827-2958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2690 Madison St Ste 130",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370436185",
            "country_code": "US",
            "telephone_number": "931-245-1701",
            "fax_number": "931-245-1720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SYNER",
        "first_name": "CLIFFORD",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-22",
        "last_updated": "2019-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100090799",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q006582",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunnyslope Dental Care 1 LLP
• Kimberly Surfus, MS, CCC-SLP
• Grace Catherine Sutton
• Lauren Sweet
• Robert Swoboda, M.D.
• Mathew Syverson, PHARMD
• T Hearts Inc.
• Danielle Takala, RPH
• Kevin Tanty, D.D.S.
• Target

• Physician Assistant in New Berlin, WI
• Providers in New Berlin, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.