ROSS W CLARK (NPI# 1104355692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104355692 |
| Entity Type | Individual |
| Full Name | ROSS W CLARK |
| Credential | PA-C |
| Practice Address |
700 S Park St Madison WI 53715-1830 |
| Practice Telephone | 6082602900 |
| Practice Fax Number | 6082602976 |
| Mailing Telephone | 6082602900 |
| Mailing Fax Number | 6082602976 |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2020-11-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 4112-23 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1104355692 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 700 S Park St, Madison, WI 537151830 | 6082602900 | 6082602976 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790200087 | Ross Jameson Clark | Registered Nurse | 2738 N Decatur Rd, Decatur, GA 30033-5910 | 2017-08-08 |
| 1821387895 | Ross Clark | Surgery | 2211 Lomas Blvd Ne, Albuquerque, NM 87106 | 2011-03-30 |
| 1821311036 | Ross Nevin Clark | Otolaryngology | 5210 Linton Blvd, Suite 307, Delray Beach, FL 33484-6542 | 2010-03-03 |
| 1700017571 | Ross Myracle Clark | Chiropractor | 1307 W Reelfoot Ave, Union City, TN 38261-5505 | 2009-07-28 |
| 1871653766 | Ross William Clark | Pharmacist | 7025 N Wickham Rd, Suite 113, Melbourne, LA 32940 | 2006-12-11 |
| Street Address |
700 S PARK ST |
| City | MADISON |
| State | WI |
| Zip Code | 53715-1830 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134123003 | Marilyn J Borst | Surgery | 700 S Park St, Madison, WI 53715-1830 | 2005-06-09 |
| 1487266714 | Charlene Jenkins | Nurse Practitioner | 700 S Park St, Madison, WI 53715-1830 | 2020-08-18 |
| 1073130480 | Amanda Mcafee | Nurse Practitioner | 700 S Park St, Madison, WI 53715-1830 | 2020-07-01 |
| 1235759150 | Edriss Drammeh | Nurse Practitioner | 700 S Park St, Madison, WI 53715-1830 | 2020-04-21 |
| 1700424777 | Elizabeth H Kuhn | Nurse Anesthetist, Certified Registered | 700 S Park St, Madison, WI 53715-1830 | 2019-12-20 |
| 1295373710 | Lauren Nicole Tobasco | Physician Assistant | 700 S Park St, Madison, WI 53715-1830 | 2019-12-16 |
| 1629610795 | Amanda L Schneider | Nurse Anesthetist, Certified Registered | 700 S Park St, Madison, WI 53715-1830 | 2019-10-10 |
| 1366092017 | Mitchell John Wilkins | Nurse Anesthetist, Certified Registered | 700 S Park St, Madison, WI 53715-1830 | 2019-09-16 |
| 1578119285 | Gary Terlizzi | Nurse Anesthetist, Certified Registered | 700 S Park St, Madison, WI 53715-1830 | 2019-08-18 |
| 1699327304 | Ann R Madden | Nurse Anesthetist, Certified Registered | 700 S Park St, Madison, WI 53715-1830 | 2019-07-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851807697 | Kristi M Batchelor | Nurse Practitioner | 20 S Park St Fl 4, Madison, WI 53715 | 2017-12-15 |
| 1578927026 | Petra A Kelsey | Family Medicine | 1107 Emerald St, Madison, WI 53715 | 2016-04-11 |
| 1467889238 | Group Health Cooperative of South Central Wi | Durable Medical Equipment & Medical Supplies | 740 Regent Street, Suite 106, Madison, WI 53715 | 2013-10-10 |
| 1275888760 | Sandra Beth Miller | Physician Assistant | 700 S. Park, Suite A 404, Madison, WI 53715 | 2012-07-20 |
| 1134418486 | Matthew Lochen | Emergency Medicine | 700 S. Park Street, Department of Emergency Medicine, Madison, WI 53715 | 2011-04-06 |
| 1225275720 | Eileen J Breitweiser | Social Worker | 202 South Parkt Street, Madison, WI 53715 | 2009-01-21 |
| 1225293137 | Kenneth H. Yuska, Md, Sc | Orthopaedic Surgery | 4726 East Towne Blvd., 110, Madison, WI 53715 | 2008-07-21 |
| 1063689727 | Rachel I Kornik | Dermatology | Uw Health Dept of Dermatology 1 S. Park St, Administrative Office 7th Floor, Madison, WI 53715 | 2008-05-13 |
| 1144434911 | Rebecca Sue Frye | Pharmacist | 1 South Park Street, Suite 101 Pharmacy, Madison, WI 53715 | 2007-05-10 |
| 1376755496 | Eileen C. Scrivner | Social Worker | 1008 Fish Hatchery Road, Madison, WI 53715 | 2007-05-03 |
| Find all providers in zip 53715 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710594403 | Mary Josephine Elliott | Physician Assistant | 50 Beechwood Dr, Madison, CT 06443-1847 | 2020-09-26 |
| 1194354928 | Shqipe Ademi | Physician Assistant | 5417 Hazelcrest Dr, Madison, WI 53704-8910 | 2020-04-03 |
| 1902432685 | Therese Rowe | Physician Assistant | 1 Point Pl Ste 200, Madison, WI 53719-2836 | 2020-03-13 |
| 1437784139 | Mark Mckinney | Physician Assistant | 750 Highland Ave # Hslc1270, Madison, WI 53705-2221 | 2020-03-03 |
| 1619511706 | Nicole Frakes | Physician Assistant | 750 Highland Ave, Madison, WI 53705-2221 | 2019-10-31 |
| 1508428558 | Martha Busse | Physician Assistant | 1650 Monroe St Apt D, Madison, WI 53711-2045 | 2019-06-30 |
| 1669942249 | Patrick Soltvedt Bohn | Physician Assistant | 1034 Waban Hill, Madison, WI 53711 | 2018-11-27 |
| 1487124020 | Kaitlyn Jolena Mcmackin | Physician Assistant | 120 Fountains Blvd Ste 1000, Madison, MS 39110-6343 | 2018-11-27 |
| 1013493907 | Paulina A Hall | Physician Assistant | 700 S Park St Suite A, Madison, WI 53715-5228 | 2018-07-13 |
| 1700370020 | Mark Diaz IIi | Physician Assistant | 77 S Oakbridge Ct Apt 105, Madison, WI 53717-2030 | 2018-06-20 |
| Find all providers in MADISON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.