KILMENY CLARK
NPI 1104443258
Physician Assistant in Bloomington, IL

Q: What is Kilmeny Clark's NPI number?

The NPI number for Kilmeny Clark is 1104443258. It was assigned to this individual provider in the NPPES registry on July 5, 2020.

Q: What is Kilmeny Clark's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Kilmeny Clark was last updated on June 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.

Active since July 05, 2020PECOS EnrolledAccepts Medicare Assignment

3024 E EMPIRE ST, BLOOMINGTON, IL 61704(309) 556-7556(309) 556-7551 Get Directions Write a Review

NPPES record last updated: June 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 9, 2025, Dec 31, 2021, Mar 9, 2021 and 1 more (4 updates tracked since 2020).

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About Kilmeny Clark NPPES

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

KILMENY CLARK (NPI 1104443258) is an individual physician assistant in Bloomington, Illinois, licensed in Illinois (085.008097) and active in the NPI registry since July 2020. She is enrolled in Medicare PECOS, is affiliated with Carle Bromenn Medical Center, and maintains a secondary practice location in Carbondale.

NPPES Registry Identity

NPI1104443258

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameKILMENY CLARK

Location Address3024 E EMPIRE STBloomington, IL 61704-5402

Mailing Address611 W Park St, FapcUrbana, IL 61801-2500

Phone(309) 556-7556

Fax(309) 556-7551

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateJuly 5, 2020

Last NPPES UpdateJune 9, 20254 updates tracked since enumeration

NPPES CertifiedMay 21, 2025

✔ NPI 1104443258 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

Licenses✔ Licensed in IL · 085.008097✔ Licensed in WI · 5318-23

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

3024 E EMPIRE ST, Bloomington, IL 61704

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Secondary Practice Location 1

Location 1300 W Oak StCarbondale, IL 62901-1400 · Phone (618) 453-8850

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

Kilmeny 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 ID3971912155

PECOS Enrollment IDI20210430000042

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.

Hospital Affiliations CMS Care Compare

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

Carle Bromenn Medical Center

Acute Care Hospitals · Normal, IL

4/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number140127

Location1304 Franklin AvenueNormal, IL 61761 · Mc Lean County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61704 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.16 – $136.56

Typical copayment $17.16 (range $4.29 – $34.14)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 19

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

CHERYL HANSEN APRN

Nurse Practitioner (Family)