BENJAMIN JACOB CLARK CRNA
NPI 1407150055
Nurse Anesthetist, Certified Registered in Elkhart, IN
About Benjamin Jacob Clark Crna NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BENJAMIN JACOB CLARK CRNA (NPI 1407150055) is an individual nurse anesthetist, certified registered in Elkhart, Indiana, licensed in Indiana (28193318A) and active in the NPI registry since December 2010. He is a graduate of Albany Medical College Of Union University (2010).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Benjamin Jacob Clark Crna 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.
Medicare Billing Reassignments
2Medicare enrollment records show Benjamin Clark reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Richland, WA 99352
- Reassigned Medicare billing, Washington enrollment
- 8 clinicians in this Medicare group
Richland, WA 99352
- Reassigned Medicare billing, Washington enrollment
- 172 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 46514 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Reported Quality Measures
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.
ELKHART, IN 46514
ELKHART, IN 46514
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 Benjamin Clark's NPI number?
The NPI number for Benjamin Clark is 1407150055. It was assigned to this individual provider in the NPPES registry on December 22, 2010.
Where is Benjamin Clark located?
Benjamin Clark practices at 600 East Blvd, Elkhart, IN 46514. The listed phone number is (574) 523-3193.
What is Benjamin Clark's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Benjamin Clark enrolled in Medicare?
Yes. Benjamin 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.
Which organizations bill Medicare for Benjamin Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Benjamin Clark reassigns Medicare benefits to 2 organizations: Apex Spine Institute (Richland, WA) and Premier Anesthesia Of Richland A Division Of Premier Anesthesia, LLC (Richland, WA). Each 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 Benjamin Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Benjamin Clark accept?
Health plans from Premera Blue Cross Blue Shield of Alaska list Benjamin Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Benjamin Clark was last updated on December 22, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.
# Benjamin Jacob Clark, CRNA · NPI 1407150055
Nurse Anesthetist, Certified Registered physician in Elkhart, Indiana. Individual provider, active in the CMS NPPES registry since December 22, 2010.
## Identity
- **NPI:** 1407150055 (Entity type: Individual)
- **Enumerated:** December 22, 2010
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 28193318A (Indiana)
- **Sole proprietor:** No
## Practice location
- **Address:** 600 EAST BLVD, Elkhart, IN 46514-2483
- **Phone:** (574) 523-3193
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Apex Spine Institute (NPI 1154081446, Richland, WA); Premier Anesthesia Of Richland A Division Of Premier Anesthesia, LLC (NPI 1013940253, Richland, WA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Albany Medical College Of Union University, class of 2010
## Record status
- **NPPES last updated:** December 22, 2010
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Source: [NPI Profile](https://npiprofile.com/npi/1407150055) · Data from the CMS NPPES public registry.