DR. KELLY CLARK DDS
NPI 1942379458
Dentist - General Practice in Decatur, IL

Q: What is Kelly Clark's NPI number?

The NPI number for Kelly Clark is 1942379458. It was assigned to this individual provider in the NPPES registry on November 7, 2006.

Q: What is Kelly Clark's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Kelly Clark was last updated on June 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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 November 07, 2006PECOS Enrolled

3737 E RTE 36, DECATUR, IL 62521(217) 423-2400(217) 423-2460 Get Directions Write a Review

NPPES record last updated: June 15, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. Kelly Clark Dds NPPES

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

DR. KELLY CLARK DDS (NPI 1942379458) is an individual general practice provider in Decatur, Illinois, licensed in Illinois (019026315) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1942379458

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. KELLY CLARKCredential: DDS

Location Address3737 E RTE 36Decatur, IL 62521-5028

Mailing Address3737 E Route 36Decatur, IL 62521 · (217) 423-2400

Phone(217) 423-2400

Fax(217) 423-2460

Sole ProprietorNo

Enumeration DateNovember 7, 2006

Last NPPES UpdateJune 15, 2026

NPPES CertifiedJune 15, 2026

✔ NPI 1942379458 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 · 019026315

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.

3737 E RTE 36, Decatur, IL 62521

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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 and more.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. Kelly Clark Dds 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 62521 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.

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 Kelly Clark's NPI number?

The NPI number for Kelly Clark is 1942379458. It was assigned to this individual provider in the NPPES registry on November 7, 2006.

Where is Kelly Clark located?

Kelly Clark practices at 3737 E Rte 36, Decatur, IL 62521. The listed phone number is (217) 423-2400.

What is Kelly Clark's specialty?

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

Is Kelly Clark enrolled in Medicare?

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

What insurance does Kelly Clark accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Anthem Blue Cross and Blue Shield and Blue Cross and Blue Shield of Alabama and 3 other insurers list Kelly 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 Kelly Clark was last updated on June 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.