Mr Evan Jacob Clark, MD - Medicare Emergency Medicine in Mount Pleasant, WI

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Mr Evan Jacob Clark, MD is a medicare enrolled "Emergency Medicine" physician in Mount Pleasant, Wisconsin. His current practice location is 13250 Washington Ave, Mount Pleasant, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (262) 799-8200.

Mr Evan Jacob Clark is licensed to practice in Wisconsin (license number 71908-20) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1154819951.

Contact Information

Mr Evan Jacob Clark, MD
13250 Washington Ave,
Mount Pleasant, WI 53177-1516
(262) 799-8200
Not Available

Map and Direction




Physician's Profile

Full NameMr Evan Jacob Clark
GenderMale
SpecialityEmergency Medicine
Location13250 Washington Ave, Mount Pleasant, Wisconsin
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1154819951
  • Provider Enumeration Date: 04/26/2018
  • Last Update Date: 04/13/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 4688009574
  • Enrollment ID: I20210820000146

Medical Identifiers

Medical identifiers for Mr Evan Jacob Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1154819951NPI-NPPES
100093430MedicaidWI

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207P00000XEmergency Medicine 2021019559 (Missouri)Secondary
390200000XStudent In An Organized Health Care Education/training Program (* (Not Available))Secondary
207P00000XEmergency Medicine 71908-20 (Wisconsin)Primary

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. Mr Evan Jacob Clark allows following entities to bill medicare on his behalf.
Entity NameMercy Clinic Joplin Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1215264817
PECOS PAC ID: 0547300196
Enrollment ID: O20091218000092
Entity NameMercy Hospital Carthage
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1003201955
PECOS PAC ID: 8426225251
Enrollment ID: O20120225000071
Entity NameMercy Hospital Carthage
Entity TypePart A Provider - Critical Access Hospital
Entity IdentifiersNPI Number: 1003201955
PECOS PAC ID: 8426225251
Enrollment ID: O20141203001963

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. Mr Evan Jacob 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
Mr Evan Jacob Clark, MD
13250 Washington Ave,
Mount Pleasant, WI 53177-1516

Ph: (262) 799-8200		Mr Evan Jacob Clark, MD
13250 Washington Ave,
Mount Pleasant, WI 53177-1516

Ph: (262) 799-8200

Reviews and Comments


Emergency Medicine Doctors in Mount Pleasant, WI

Dr. James Samuel, M.D.
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 8400 Washington Ave, Mount Pleasant, WI 53406
Phone: 262-884-4088    Fax: 262-884-4078
Michael G Manske, M.D.
Emergency Medicine
Medicare: Medicare Enrolled
Practice Location: 8400 Washington Ave, Mount Pleasant, WI 53406
Phone: 262-884-4088    
Dr. Joseph Thomas Humphrey, M.D.
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 3801 Spring St, Mount Pleasant, WI 53405
Phone: 262-687-4201    Fax: 262-687-4334
Dr. Suhas Channappa, M.D.,
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 13250 Washington Ave, Mount Pleasant, WI 53177
Phone: 888-720-2012    
Dr. Matthew John Clark, M.D.
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 3801 Spring St, Mount Pleasant, WI 53405
Phone: 262-687-4493    
Dr. Maria Gomez, MD
Emergency Medicine
Medicare: Medicare Enrolled
Practice Location: 13250 Washington Ave, Mount Pleasant, WI 53177
Phone: 888-720-2012    

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.