DR. KASANDRIA CLARK MD
NPI 1801538251
Pediatrics in Chicago, IL

Q: What is Kasandria Clark's NPI number?

The NPI number for Kasandria Clark is 1801538251. It was assigned to this individual provider in the NPPES registry on April 7, 2022.

Q: What is Kasandria Clark's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Kasandria Clark was last updated on June 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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 07, 2022PECOS Enrolled

1555 W HOWARD ST, CHICAGO, IL 60626(773) 764-7146 Get Directions Write a Review

NPPES record last updated: June 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 9, 2025, Apr 7, 2022 (2 updates tracked since 2022).

On this page

About Dr. Kasandria Clark Md NPPES

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

DR. KASANDRIA CLARK MD (NPI 1801538251) is an individual pediatrics provider in Chicago, Illinois, licensed in Illinois (036172412) and active in the NPI registry since April 2022. She is enrolled in Medicare PECOS, maintains a secondary practice location in Park Ridge, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1801538251

Entity TypeIndividualFemale

Primary Taxonomy208000000X

Provider Legal NameDR. KASANDRIA CLARKCredential: MD

Location Address1555 W HOWARD STChicago, IL 60626-1707

Mailing Address4104 N Western Ave Apt 3nChicago, IL 60618-2848 · (618) 558-4233

Phone(773) 764-7146

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateApril 7, 2022

Last NPPES UpdateJune 9, 20252 updates tracked since enumeration

NPPES CertifiedJune 9, 2025

✔ NPI 1801538251 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in IL · 036172412

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

1555 W HOWARD ST, Chicago, IL 60626

Open in Google Maps ↗

Secondary Practice Location 1

Location 11675 Dempster StPark Ridge, IL 60068-1110 · Phone (847) 318-9300

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kasandria Clark Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7012425259

PECOS Enrollment IDI20250731001275

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 60626 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

$94.06 typical visit price

range $60.08 – $183.39

Typical copayment $23.51 (range $15.02 – $45.84)

Most-billed visit code 99203

Established Patient

$105.70 typical visit price

range $18.97 – $148.12

Typical copayment $26.42 (range $4.74 – $37.03)

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 7

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

LUKE WILLIAM AGASE PA-C

Physician Assistant