JACOB TYLER CLARK MD
NPI 1437512613
Emergency Medicine in Green Bay, WI

Q: What is Jacob Clark's NPI number?

The NPI number for Jacob Clark is 1437512613. It was assigned to this individual provider in the NPPES registry on April 4, 2016.

Q: What is Jacob Clark's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Q: When was this NPI record last updated?

The NPPES record for Jacob Clark was last updated on April 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since April 04, 2016PECOS EnrolledAccepts Medicare Assignment

2845 GREENBRIER RD, GREEN BAY, WI 54311(920) 288-4060(920) 288-4067 Get Directions Write a Review

NPPES record last updated: April 21, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 21, 2026, Apr 11, 2024, Dec 2, 2019 and 1 more (4 updates tracked since 2017).

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About Jacob Tyler Clark Md NPPES

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

JACOB TYLER CLARK MD (NPI 1437512613) is an individual emergency medicine provider in Green Bay, Wisconsin, licensed in Wisconsin (6446-851) and active in the NPI registry since April 2016. He is enrolled in Medicare PECOS, is affiliated with Aurora Medical Ctr Manitowoc County, and is a graduate of New York Medical College (2016).

NPPES Registry Identity

NPI1437512613

Entity TypeIndividualMale

Primary Taxonomy207P00000X

Provider Legal NameJACOB TYLER CLARKCredential: MD

Location Address2845 GREENBRIER RDGreen Bay, WI 54311-6519

Mailing Address1035 Kepler DrGreen Bay, WI 54311-8320 · (920) 490-9046 · Fax (920) 405-8005

Phone(920) 288-4060

Fax(920) 288-4067

Sole ProprietorNo

Medical School CMSNew York Medical CollegeGraduated 2016

Enumeration DateApril 4, 2016

Last NPPES UpdateApril 21, 20264 updates tracked since enumeration

NPPES CertifiedApril 21, 2026

✔ NPI 1437512613 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207P00000X

License✔ Licensed in WI · 6446-851

Definition

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

2845 GREENBRIER RD, Green Bay, WI 54311

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Other Identifiers 1

Medicaid100057535WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource (Common Ground Healthcare).Insurance ›

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

Jacob Tyler Clark Md 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.

PECOS PAC ID4688967417

PECOS Enrollment IDI20190725003837

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.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with high level of medical decision making 99285

An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.

183 services174 patients

Emergency department visit with moderate level of medical decision making 99284

An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.

46 services46 patients

Critical care, first 30-74 minutes 99291

Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.

36 services36 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010

A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.

25 services25 patients

Emergency department visit with low level of medical decision making 99283

An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.

22 services22 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

21 services21 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Aurora Medical Ctr Manitowoc County

Acute Care Hospitals · Two Rivers, WI

OwnershipVoluntary non-profit - Private

CMS Certification Number520034

Location5000 Memorial DriveTwo Rivers, WI 54241 · Manitowoc County

Emergency services Birthing friendly

Bay Area Medical Center

Acute Care Hospitals · Marinette, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520113

Location3003 University DrMarinette, WI 54143 · Marinette County

Emergency services Birthing friendly

Aurora Baycare Medical Ctr

Acute Care Hospitals · Green Bay, WI

5/5 CMS rating

OwnershipProprietary

CMS Certification Number520193

Location2845 Greenbrier RdGreen Bay, WI 54311 · Brown County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54311 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

Most-billed visit code 99214

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.

AMRITHA CHANDRAHASA KARKERA M.D.

Internal Medicine (Hematology & Oncology)