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JACOB CLARK
NPI 1013614304
Physician Assistant - Medical in Peoria, IL

Active since February 08, 2023PECOS EnrolledAccepts Medicare Assignment
530 NE GLEN OAK AVE, PEORIA, IL 61637(309) 655-2000 Get Directions Write a Review

NPPES record last updated: April 7, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 7, 2023, Feb 8, 2023 (2 updates tracked since 2023).

About Jacob Clark NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACOB CLARK (NPI 1013614304) is an individual medical provider in Peoria, Illinois and active in the NPI registry since February 2023. He is enrolled in Medicare PECOS, is affiliated with Saint Francis Medical Center, and is a graduate of Yale University School Of Medicine (2023).

NPPES Registry Identity

NPI1013614304
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameJACOB CLARK
Location Address530 NE GLEN OAK AVEPeoria, IL 61637-0001
Mailing Address4537 Tundra LnMcfarland, WI 53558-9158 · (605) 521-8056
Phone(309) 655-2000
Sole ProprietorNo
Medical School CMSYale University School Of MedicineGraduated 2023
Enumeration DateFebruary 8, 2023
Last NPPES UpdateApril 7, 20232 updates tracked since enumeration
NPPES CertifiedApril 7, 2023
✔ NPI 1013614304 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
530 NE GLEN OAK AVE, Peoria, IL 61637
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacob Clark is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2466806401
PECOS Enrollment IDI20230926001067
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
15 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Saint Francis Medical Center

Acute Care Hospitals · Peoria, IL
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140067
Location530 NE Glen Oak AvePeoria, IL 61637 · Peoria County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DEEPAK S NAIR M.D.
Psychiatry & Neurology (Neurology)
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
DR. HAMID MAHMOOD ZIA M.D
Pathology (Anatomic Pathology & Clinical Pathology)
530 NE GLEN OAK AVE, CENTRAL ILLINOIS PATHOLOGY SC
PEORIA, IL 61637
Peoria County (309) 624-9011
THOMAS JAMES MCMORROW MD
Pediatrics
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2553
ERIC TYLER AMPARAN MD
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2274
ALEXANDRA ROPER MD
Surgery
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
JAPMEHR KAUR SANDHU M.B.B.S.
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 624-9351
THOMAS BLACKWELL JR. MD
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
LUKE KLOFT
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2109

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Clark's NPI number?

The NPI number for Jacob Clark is 1013614304. It was assigned to this individual provider in the NPPES registry on February 8, 2023.

Where is Jacob Clark located?

Jacob Clark practices at 530 NE Glen Oak Ave, Peoria, IL 61637. The listed phone number is (309) 655-2000.

What is Jacob Clark's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Jacob Clark enrolled in Medicare?

Yes. Jacob Clark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Jacob Clark affiliated with any hospitals?

According to CMS data, Jacob Clark is affiliated with Saint Francis Medical Center.

When was this NPI record last updated?

The NPPES record for Jacob Clark was last updated on April 7, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.