KRISTIN ELISE CLARK MD
NPI 1164764585
Anesthesiology in Plymouth, MN

Q: What is Kristin Clark's NPI number?

The NPI number for Kristin Clark is 1164764585. It was assigned to this individual provider in the NPPES registry on March 24, 2013.

Q: What is Kristin Clark's specialty?

The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.

Q: When was this NPI record last updated?

The NPPES record for Kristin Clark was last updated on September 26, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 24, 2013PECOS Enrolled

14700 28TH AVE N STE 20, PLYMOUTH, MN 55447(763) 559-3779(763) 450-3986 Get Directions Write a Review

NPPES record last updated: September 26, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Kristin Elise Clark Md NPPES

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

KRISTIN ELISE CLARK MD (NPI 1164764585) is an individual anesthesiology provider in Plymouth, Minnesota, licensed in Minnesota (64496) and active in the NPI registry since March 2013. She is enrolled in Medicare PECOS and maintains a secondary practice location in Milwaukee.

NPPES Registry Identity

NPI1164764585

Entity TypeIndividualFemale

Primary Taxonomy207L00000X

Provider Legal NameKRISTIN ELISE CLARKCredential: MD

Location Address14700 28TH AVE N STE 20Plymouth, MN 55447-4876

Mailing AddressPo Box 47159Plymouth, MN 55447-0159 · (763) 559-3779 · Fax (763) 450-3986

Phone(763) 559-3779

Fax(763) 450-3986

Sole ProprietorNo

Enumeration DateMarch 24, 2013

Last NPPES UpdateSeptember 26, 2018

✔ NPI 1164764585 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAnesthesiologyAllopathic & Osteopathic Physicians

Taxonomy Code207L00000X

License✔ Licensed in MN · 64496

Definition

An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

14700 28TH AVE N STE 20, Plymouth, MN 55447

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Secondary Practice Location 1

Location 18701 W Watertown Plank RdMilwaukee, WI 53226-3548 · Phone (414) 955-4575

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kristin Elise Clark Md 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.

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.

PETER WILLIAM COLEMAN

Anesthesiology