MR. DYLAN ROSS CLARK STUDENT
NPI 1104530930
Nurse Anesthetist, Certified Registered in Boston, MA
About Mr. Dylan Ross Clark Student NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. DYLAN ROSS CLARK STUDENT (NPI 1104530930) is an individual nurse anesthetist, certified registered in Boston, Massachusetts, licensed in Massachusetts (RN2287470) and active in the NPI registry since January 2023. He is affiliated with Boston Medical Center, maintains a secondary practice location in Chestnut Hill, and is a graduate of Other (2025).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Other Identifiers 2
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
Mr. Dylan Ross Clark Student 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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Boston Medical Center
Acute Care Hospitals · Boston, MAPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 02118 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.
BOSTON, MA 02118
BOSTON, MA 02118
BOSTON, MA 02118
BOSTON, MA 02118
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 Dylan Clark's NPI number?
The NPI number for Dylan Clark is 1104530930. It was assigned to this individual provider in the NPPES registry on January 6, 2023.
Where is Dylan Clark located?
Dylan Clark practices at 1 Boston Medical Center Place, Boston, MA 02118. The listed phone number is (617) 638-6950.
What is Dylan Clark's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Dylan Clark enrolled in Medicare?
Yes. Dylan 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 Dylan Clark affiliated with any hospitals?
According to CMS data, Dylan Clark is affiliated with Boston Medical Center.
When was this NPI record last updated?
The NPPES record for Dylan Clark was last updated on April 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Mr. Dylan Ross Clark, STUDENT · NPI 1104530930
Nurse Anesthetist, Certified Registered physician in Boston, Massachusetts. Individual provider, active in the CMS NPPES registry since January 6, 2023.
## Identity
- **NPI:** 1104530930 (Entity type: Individual)
- **Enumerated:** January 6, 2023
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** RN2287470 (Massachusetts)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1 BOSTON MEDICAL CENTER PLACE, Boston, MA 02118
- **Phone:** (617) 638-6950
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Medical school:** Other, class of 2025
## Record status
- **NPPES last updated:** April 2, 2026
- **Other identifiers:** Medicaid 110224269A (MA); Medicaid 3150309 (NH)
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Source: [NPI Profile](https://npiprofile.com/npi/1104530930) · Data from the CMS NPPES public registry.