ELLICE CLARK
NPI 1679287395
Nurse Anesthetist, Certified Registered in Ann Arbor, MI
About Ellice Clark NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ELLICE CLARK (NPI 1679287395) is an individual nurse anesthetist, certified registered in Ann Arbor, Michigan, licensed in Michigan (4704345479) and active in the NPI registry since January 2023. She is affiliated with Beaumont Hospital - Dearborn and is a graduate of Other (2024).
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 (PECOS)
Ellice Clark is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Ellice Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Irving, TX 75038
- Reassigned Medicare billing, Michigan enrollment
- 905 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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Beaumont Hospital - Dearborn
Acute Care Hospitals · Dearborn, MIOther Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
ANN ARBOR, MI 48109
ANN ARBOR, MI 48109
ANN ARBOR, MI 48109
ANN ARBOR, MI 48109
ANN ARBOR, MI 48109
ANN ARBOR, MI 48109
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 Ellice Clark's NPI number?
The NPI number for Ellice Clark is 1679287395. It was assigned to this individual provider in the NPPES registry on January 9, 2023.
Where is Ellice Clark located?
Ellice Clark practices at 1500 E Medical Center Dr, Ann Arbor, MI 48109. The listed phone number is (734) 936-4000.
What is Ellice Clark's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Ellice Clark enrolled in Medicare?
Yes. Ellice Clark is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Ellice Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Ellice Clark reassigns Medicare benefits to Northstar Anesthesia Of Michigan III PLLC (Irving, TX). 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 Ellice Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Ellice Clark accept?
Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Ellice 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.
Is Ellice Clark affiliated with any hospitals?
According to CMS data, Ellice Clark is affiliated with Beaumont Hospital - Dearborn.
When was this NPI record last updated?
The NPPES record for Ellice Clark was last updated on November 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 days 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.
# Ellice Clark · NPI 1679287395
Nurse Anesthetist, Certified Registered physician in Ann Arbor, Michigan. Individual provider, active in the CMS NPPES registry since January 9, 2023.
## Identity
- **NPI:** 1679287395 (Entity type: Individual)
- **Enumerated:** January 9, 2023
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 4704345479 (Michigan)
- **Sole proprietor:** No
## Practice location
- **Address:** 1500 E MEDICAL CENTER DR, Ann Arbor, MI 48109-5000
- **Phone:** (734) 936-4000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Northstar Anesthesia Of Michigan III PLLC (NPI 1972126209, Irving, TX), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** November 4, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1679287395) · Data from the CMS NPPES public registry.