Kyley Clark, - Medicare Certified Registered Nurse Anesthetist (crna) in South Bend, IN

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Kyley Clark, is a medicare enrolled "Nurse Anesthetist, Certified Registered" in South Bend, Indiana. She went to Marian University College Of Osteopathic Medicine and graduated in 2022 and has 2 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). She is a member of the group practice Ams Northern Indiana Llc, Great Lakes Anesthesia Pc, Southeast Anesthesiologists, Inc. and her current practice location is 615 N Michigan St, South Bend, Indiana. You can reach out to her office (for appointments etc.) via phone at (574) 647-1000.

Kyley Clark is licensed to practice in Indiana (license number 28230241A) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1003545831.

Contact Information

Kyley Clark,
615 N Michigan St,
South Bend, IN 46601-1087
(574) 647-1000
Not Available

Map and Direction




Provider's Profile

Full NameKyley Clark
GenderFemale
SpecialityCertified Registered Nurse Anesthetist (crna)
Experience2 Years
Location615 N Michigan St, South Bend, Indiana
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Kyley Clark attended and graduated from Marian University College Of Osteopathic Medicine in 2022
  NPI Data:
  • NPI Number: 1003545831
  • Provider Enumeration Date: 06/07/2022
  • Last Update Date: 06/09/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 6608255039
  • Enrollment ID: I20220615001831

Medical Identifiers

Medical identifiers for Kyley Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1003545831NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
367500000XNurse Anesthetist, Certified Registered 28230241A (Indiana)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Memorial Hospital Of South BendSouth bend, INHospital
Saint Joseph Regional Medical Center - PlymouthPlymouth, INHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Ams Northern Indiana Llc802244430612
Great Lakes Anesthesia Pc064818344211
Southeast Anesthesiologists, Inc.680083798092

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kyley Clark allows following entities to bill medicare on her behalf.
Entity NameGreat Lakes Anesthesia Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1720039977
PECOS PAC ID: 0648183442
Enrollment ID: O20031107000452
Entity NameSoutheast Anesthesiologists, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1548210685
PECOS PAC ID: 6800837980
Enrollment ID: O20050518001265
Entity NameAms Northern Indiana Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1427619840
PECOS PAC ID: 8022444306
Enrollment ID: O20200205000244

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kyley Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Kyley Clark,
51575 Shaker Ln,
Granger, IN 46530-7137

Ph: (812) 229-8820		Kyley Clark,
615 N Michigan St,
South Bend, IN 46601-1087

Ph: (574) 647-1000

Reviews and Comments


Nurse Anesthetist, Certified Registered Nurses in South Bend, IN

Ms. Jamie Ann Davidson, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 1536 Crestwood Blvd, South Bend, IN 46635
Phone: 574-360-2619    
Alvaro Andres Osorio,
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 615 N Michigan St, South Bend, IN 46601
Phone: 574-647-1000    
Hilda Bartel,
Nurse Anesthetist - CR
Medicare: Medicare Enrolled
Practice Location: 615 N Michigan St, South Bend, IN 46601
Phone: 574-647-1000    
Mrs. Julie Anne Addis, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 53830 Generations Dr, South Bend, IN 46635
Phone: 574-271-0893    
Janet Vardaman, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 17501 Generations Dr, South Bend, IN 46635
Phone: 574-234-0049    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.