CLARK D ANDELIN DMD, MD
NPI 1043538705
Dentist - Oral and Maxillofacial Surgery in Philadelphia, PA
About Clark D Andelin Dmd, Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CLARK D ANDELIN DMD, MD (NPI 1043538705) is an individual oral and maxillofacial surgery provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (DS038552) and active in the NPI registry since May 2010. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Clark D Andelin Dmd, Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Clark Andelin reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Plainfield, VT 05667
- Reassigned Medicare billing, Vermont enrollment
- 26 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 19104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
PHILADELPHIA, PA 19104
PHILADELPHIA, PA 19104
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 Clark Andelin's NPI number?
The NPI number for Clark Andelin is 1043538705. It was assigned to this individual provider in the NPPES registry on May 5, 2010.
Where is Clark Andelin located?
Clark Andelin practices at 3400 Spruce St, Philadelphia, PA 19104. The listed phone number is (215) 662-6176.
What is Clark Andelin's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.
Is Clark Andelin enrolled in Medicare?
Yes. Clark Andelin is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Clark Andelin's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Clark Andelin reassigns Medicare benefits to Northeast Washington County Community Health, Inc. (Plainfield, VT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Clark Andelin's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Clark Andelin accept?
Health plans from Anthem Blue Cross and Blue Sheld, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 1 other insurer list Clark Andelin as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Clark Andelin was last updated on January 20, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Clark D Andelin, DMD, MD · NPI 1043538705
Oral and Maxillofacial Surgery provider in Philadelphia, Pennsylvania. Individual provider, active in the CMS NPPES registry since May 5, 2010.
## Identity
- **NPI:** 1043538705 (Entity type: Individual)
- **Enumerated:** May 5, 2010
- **Primary specialty:** Dentist - Oral and Maxillofacial Surgery · taxonomy 1223S0112X
- **State license:** DS038552 (Pennsylvania)
- **Sole proprietor:** No
## Practice location
- **Address:** 3400 SPRUCE ST, Philadelphia, PA 19104-4206
- **Phone:** (215) 662-6176
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Northeast Washington County Community Health, Inc. (NPI 1699755348, Plainfield, VT), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 20, 2017
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Source: [NPI Profile](https://npiprofile.com/npi/1043538705) · Data from the CMS NPPES public registry.