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KYLE ALLEN CLARK D.M.D.
NPI 1639521206
Dentist - General Practice in Salem, IL

Active since July 07, 2016PECOS Enrolled
113 CROSS CREEK BLVD, SALEM, IL 62881(618) 548-4480 Get Directions Write a Review

NPPES record last updated: July 7, 2016. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Kyle Allen Clark D.m.d. NPPES

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

KYLE ALLEN CLARK D.M.D. (NPI 1639521206) is an individual general practice provider in Salem, Illinois, licensed in Illinois (019030831) and active in the NPI registry since July 2016. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1639521206
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameKYLE ALLEN CLARKCredential: D.M.D.
Location Address113 CROSS CREEK BLVDSalem, IL 62881-1921
Mailing Address113 Cross Creek BlvdSalem, IL 62881-1921 · (618) 548-4480
Phone(618) 548-4480
Sole ProprietorNo
Enumeration DateJuly 7, 2016
✔ NPI 1639521206 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in IL · 019030831
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
113 CROSS CREEK BLVD, Salem, IL 62881
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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)

Kyle Allen Clark D.m.d. 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 62881 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$68.64 typical visit price
range $17.16 – $136.56
Typical copayment $17.16 (range $4.29 – $34.14)
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

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

DR. STANLEY E MORRISON D.D.S
Dentist (General Practice)
113 CROSS CREEK BLVD
SALEM, IL 62881
Marion County (618) 548-4480

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 Kyle Clark's NPI number?

The NPI number for Kyle Clark is 1639521206. It was assigned to this individual provider in the NPPES registry on July 7, 2016.

Where is Kyle Clark located?

Kyle Clark practices at 113 Cross Creek Blvd, Salem, IL 62881. The listed phone number is (618) 548-4480.

What is Kyle Clark's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Kyle Clark enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Kyle Clark was last updated on July 7, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.