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KRISTIN ELISE CLARK MD
NPI 1164764585
Anesthesiology in Plymouth, MN

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: October 25, 2026.

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

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.

Medicare Billing Reassignment

Medicare enrollment records show Kristin Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Metropolitan Anesthesia Network, LLP
Same address
Anesthesiology
14700 28TH AVE N, SUITE 20
Plymouth, MN 55447
  • Reassigned Medicare billing, Minnesota enrollment
  • 1,033 clinicians in this Medicare group
NPI 1558314427 (763) 559-3779

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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
14700 28TH AVE N STE 20
PLYMOUTH, MN 55447
Hennepin County (635) 593-7797
MEGAN ANN BORELLI
Nurse Anesthetist, Certified Registered
14700 28TH AVE N STE 20
PLYMOUTH, MN 55447
Hennepin County (763) 559-3779
NICKOLAS C SOUTHWICK CRNA
Nurse Anesthetist, Certified Registered
14700 28TH AVE N STE 20
PLYMOUTH, MN 55447
Hennepin County (763) 559-3779
LORNA BECHTEL
Nurse Anesthetist, Certified Registered
14700 28TH AVE N STE 20
PLYMOUTH, MN 55447
Hennepin County (763) 559-3379
ANNA SPILLERS
Nurse Anesthetist, Certified Registered
14700 28TH AVE N STE 20
PLYMOUTH, MN 55447
Hennepin County (763) 559-3779
KATHRYN MARIE HUBER SRNA
Nurse Anesthetist, Certified Registered
14700 28TH AVE N STE 20
PLYMOUTH, MN 55447
Hennepin County (763) 559-3779
DR. JEFFREY MARK WISE II DO
Anesthesiology
14700 28TH AVE N STE 20
PLYMOUTH, MN 55447
Hennepin County (763) 559-3779
MRS. GRETA SCHILLING HUNT CRNA
Nurse Anesthetist, Certified Registered
14700 28TH AVE N STE 20
PLYMOUTH, MN 55447
Hennepin County (763) 559-3779

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 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.

Where is Kristin Clark located?

Kristin Clark practices at 14700 28th Ave N Ste 20, Plymouth, MN 55447. The listed phone number is (763) 559-3779.

What is Kristin Clark's specialty?

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

Is Kristin Clark enrolled in Medicare?

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

Which organization bills Medicare for Kristin Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kristin Clark reassigns Medicare benefits to Metropolitan Anesthesia Network, LLP (Plymouth, MN). 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 Kristin Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kristin Clark was last updated on September 26, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.