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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

GRANT WILLIAM CLARK
NPI 1134007487
Physician Assistant in Waterloo, IA

Active since August 25, 2025PECOS Enrolled
1825 LOGAN AVE, WATERLOO, IA 50703(319) 235-3941 Get Directions Write a Review

NPPES record last updated: September 23, 2026. Verified against the NPPES registry weekly; last sync: October 11, 2026.

About Grant William Clark NPPES

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

GRANT WILLIAM CLARK (NPI 1134007487) is an individual physician assistant in Waterloo, Iowa, licensed in Iowa (141166) and active in the NPI registry since August 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1134007487
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameGRANT WILLIAM CLARK
Location Address1825 LOGAN AVEWaterloo, IA 50703-1916
Mailing Address4834 Valley View LnWest Des Moines, IA 50265-5226 · (515) 537-5551
Phone(319) 235-3941
Sole ProprietorNo
Enumeration DateAugust 25, 2025
Last NPPES UpdateSeptember 23, 2026
NPPES CertifiedSeptember 23, 2026
✔ NPI 1134007487 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in IA · 141166
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.
1825 LOGAN AVE, Waterloo, IA 50703
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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 (PECOS)

Grant William Clark is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 50703 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
$81.84 typical visit price
range $52.96 – $161.40
Typical copayment $20.46 (range $13.24 – $40.35)
Most-billed visit code 99203
Established Patient
$66.36 typical visit price
range $16.91 – $131.98
Typical copayment $16.59 (range $4.22 – $32.99)
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 20

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

DR. KEERAN GHANDIVEL MD
Anesthesiology
1825 LOGAN AVE
WATERLOO, IA 50703
Black Hawk County (319) 235-3886
MS. AMANDA L. VERVAECKE A.R.N.P.
Nurse Practitioner
1825 LOGAN AVE, WOUND & OSTOMY CLINIC
WATERLOO, IA 50703
Black Hawk County (319) 235-3121
TAYLOR KRISTIN KLINE PA, RDN
Physician Assistant
1825 LOGAN AVE
WATERLOO, IA 50703
Black Hawk County (319) 235-3941
ALLEN MEMORIAL HOSPITAL CORPORATION LAB
Clinical Medical Laboratory
1825 LOGAN AVE
WATERLOO, IA 50703
Black Hawk County (319) 235-3941
ELVIS SABIC ARNP
Nurse Practitioner (Family)
1825 LOGAN AVE
WATERLOO, IA 50703
Black Hawk County (319) 235-3941
DR. PRADEEP MANJANBAIL RAMESH MD
Internal Medicine
1825 LOGAN AVE
WATERLOO, IA 50703
Black Hawk County (319) 235-3838
SUSAN MUELLER PHARMD
Pharmacist
1825 LOGAN AVE
WATERLOO, IA 50703
Black Hawk County (319) 235-3510
HANNAH LEIGH KELLEY LMSW
Social Worker (Clinical)
1825 LOGAN AVE
WATERLOO, IA 50703
Black Hawk County (563) 271-7700

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 Grant Clark's NPI number?

The NPI number for Grant Clark is 1134007487. It was assigned to this individual provider in the NPPES registry on August 25, 2025.

Where is Grant Clark located?

Grant Clark practices at 1825 Logan Ave, Waterloo, IA 50703. The listed phone number is (319) 235-3941.

What is Grant Clark's specialty?

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

Is Grant Clark enrolled in Medicare?

Yes. Grant Clark is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Grant Clark was last updated on September 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 days 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.