MR. JOHN RILEY CLARK (NPI# 1063072973) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063072973 |
| Entity Type | Individual |
| Full Name | MR. JOHN RILEY CLARK |
| Credential | PA-C |
| Practice Address |
2700 Light Rd Apt 102 Oswego IL 60543-9231 |
| Practice Telephone | 4155168668 |
| Mailing Telephone | 4155168668 |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2019-08-02 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
085.007136 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245890672 | John Douglas Clark Jr. | Family Medicine | 54 Meadowbrook Cir, Brevard, NC 28712-8543 | 2019-06-18 |
| 1871909986 | John Clark | Internal Medicine | 740 Bethlehem Pike, Flourtown, PA 19031-1318 | 2014-07-09 |
| 1831444017 | John Arnot Clark | Dermatology | 1849 Mission Ridge Road, Santa Barbara, CA 93103-1857 | 2012-07-13 |
| 1427327428 | John Jacob Clark | Pharmacist | 1312 Northland Drive, Mendota Heights, MN 55120 | 2011-12-20 |
| 1841580586 | John Alan Clark | Pharmacist | 1900 Argillite Rd, Flatwoods, KY 41139-1616 | 2011-04-14 |
| 1740586932 | John Casey Clark | Occupational Therapist | 448 Lewis Hargett Cir, Suite 100, Lexington, KY 40503-3594 | 2011-02-04 |
| 1023327921 | John M Clark | Social Worker | 3528 Manchester Rd, Wantagh, NY 11793-3010 | 2010-09-27 |
| 1831417922 | John Russell Clark | Speech-Language Pathologist | 7811 Cobden Rd, Laverock, PA 19038-7257 | 2010-05-13 |
| 1518151513 | John M Clark | Physical Therapist | 1202 Se 6th St, Wagoner, OK 74467-6316 | 2007-09-02 |
| 1164625653 | John Glenn Clark | Orthopaedic Surgery | 111 Whiskeag Rd, Bath, ME 04530-4127 | 2007-06-11 |
| Street Address |
2700 LIGHT RD APT 102 |
| City | OSWEGO |
| State | IL |
| Zip Code | 60543-9231 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687332 | Graceful Therapy, LLC | Marriage & Family Therapist | 2683 Route 34, Oswego, IL 60543 | 2018-07-30 |
| 1235669763 | Elizabeth Lassandrello Bremner | Counselor | 123 W. Washington St, Oswego, IL 60543 | 2017-06-18 |
| 1205365699 | The Wisdom Shuttle, Inc. | Non-emergency Medical Transport (VAN) | 234 Springbrook Trail South, Oswego, IL 60543 | 2017-06-08 |
| 1477003267 | Smart Choice Mri, LLC | Clinic/Center | 2752 Us Highway 34, Oswego, IL 60543 | 2016-10-05 |
| 1033588686 | George Pearah | Internal Medicine | 408 Sudbury Circle, Oswego, IL 60543 | 2015-09-24 |
| 1619375078 | Kathryn Elyse Fish | Marriage & Family Therapist | 123 W Washington St Ste B-08, Oswego, IL 60543 | 2014-12-16 |
| 1821410713 | Amanda Southwell | Social Worker | 512 Affirmed Dr, Oswego, IL 60543 | 2014-01-10 |
| 1073852158 | James A. Sandrolini | Surgery | 245 Gray's Dr., Oswego, IL 60543 | 2013-02-08 |
| 1649514035 | Kelly L Mangler | Pharmacist | 2030 Route 34, Oswego, IL 60543 | 2012-11-26 |
| 1730483280 | Little Talkers, Speech and Language Therapy, LLC | Speech-Language Pathologist | 809 Barton Drive, Oswego, IL 60543 | 2010-12-27 |
| Find all providers in zip 60543 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023651742 | Jessica Lynn Metzger | Physician Assistant | 300 Ny-104 Suite 1, Oswego, NY 13126 | 2019-10-25 |
| 1114476231 | Emily Crandell | Physician Assistant | 300 State Route 104, Oswego, NY 13126-2956 | 2016-09-30 |
| 1154630366 | Bobbie Rae Faivus Vangorder | Physician Assistant | 110 W Utica St, Oswego, NY 13126-3047 | 2010-10-05 |
| 1457477499 | Curtis Charles Lieber | Physician Assistant | 10 George St, Oswego, NY 13126-3276 | 2007-03-21 |
| 1144320862 | Alexander James Brown | Physician Assistant | 110 W 6th St, Oswego, NY 13126-2507 | 2006-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707298 | Eliza Ballen | Physician Assistant | 335 Sylvan Rd, Lake Bluff, IL 60044-2562 | 2020-07-21 |
| 1477177947 | Rybecca Janovyak | Physician Assistant | 14432 High Rd, Lockport, IL 60441-9402 | 2020-06-01 |
| 1518591759 | Julie Jenkot | Physician Assistant | 333 N Michigan Ave Fl 14, Chicago, IL 60601-3901 | 2020-02-26 |
| 1801429873 | Hinjal D Jha | Physician Assistant | 22285 N Pepper Rd Ste 409, Lake Barrington, IL 60010-2542 | 2020-02-19 |
| 1770120222 | Alvina Shaikh | Physician Assistant | 4009 Warren Ave, Bellwood, IL 60104-2066 | 2019-12-03 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1538705272 | Bethany Mae Frisby | Physician Assistant | 8630 W Golf Rd, Niles, IL 60714-5600 | 2019-11-18 |
| 1134761984 | Ella-marie Rakowski | Physician Assistant | 25 Acorn Dr, Hawthorn Woods, IL 60047-7407 | 2019-10-14 |
| 1467001859 | Timothy Omotayo Adesanya | Physician Assistant | Graham Correctional Center, 12078 Illinois Rte 185, Hilliboro, IL 62049 | 2019-09-09 |
| 1518514066 | Victoria Moore | Physician Assistant | 979 W Main St, West Dundee, IL 60118-2088 | 2019-08-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.