Benjamin Jacob Clark, CRNA in Elkhart, IN - Medicare Nurse Anesthetist, Certified Registered

Benjamin Jacob Clark, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Elkhart, Indiana. His current practice location is 600 East Blvd, Elkhart, Indiana. You can reach out to his office (for appointments etc.) via phone at (574) 523-3193.

Benjamin Jacob Clark is licensed to practice in Indiana (license number 28193318A) 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 1407150055.

Contact Information

	Benjamin Jacob Clark, CRNA
	600 East Blvd, Elkhart, IN 46514-2483
	(574) 523-3193
	Not Available

Map and Direction

Provider's Profile

Full Name	Benjamin Jacob Clark
Gender	Male
Speciality	Nurse Anesthetist, Certified Registered
Location	600 East Blvd, Elkhart, Indiana
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1407150055
Provider Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010

Medicare PECOS Information:

PECOS PAC ID: 4688858285
Enrollment ID: I20181217002203

Medical Identifiers

Medical identifiers for Benjamin Jacob Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1407150055	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367500000X	Nurse Anesthetist, Certified Registered	28193318A (Indiana)	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. Benjamin Jacob Clark allows following entities to bill medicare on his behalf.

Entity Name	Premier Anesthesia Of Richland A Division Of Premier Anesthesia, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1013940253 PECOS PAC ID: 4880699172 Enrollment ID: O20060920000047

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. Benjamin 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 Address	Practice Location Address
Benjamin Jacob Clark, CRNA 14660 Carrigan Ct, Granger, IN 46530-4222 Ph: (574) 523-3193	Benjamin Jacob Clark, CRNA 600 East Blvd, Elkhart, IN 46514-2483 Ph: (574) 523-3193

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Elkhart, IN

Mark Mcpherson, RN Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 600 East Blvd, Elkhart, IN 46514 Phone: 574-523-3193
Ms. Barbara Ann Doherty, C.R.N.A. Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1004 Parkway Ave, Suite B, Elkhart, IN 46516 Phone: 574-522-9922 Fax: 574-522-9926
Lindsay Vasil, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1513 E Jackson Blvd, Elkhart, IN 46516 Phone: 574-523-3193
Denise Christine Brown, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 600 East Blvd, Elkhart, IN 46514 Phone: 574-523-3193 Fax: 574-523-3463
Patty Jean Garlick, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 3080 Windsor Ct, Ste B, Elkhart, IN 46514 Phone: 574-266-7817
Sara L Mcnally, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 500 N Nappanee St, Ste 11-b, Elkhart, IN 46514 Phone: 574-522-9922 Fax: 574-522-9926
Breann Marie Kutzer Mcmanus, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 500 N Nappanee St, Suite 11-b, Elkhart, IN 46514 Phone: 574-522-9922 Fax: 574-522-9926

Benjamin Jacob Clark, CRNA - Medicare Nurse Anesthetist, Certified Registered in Elkhart, IN