BENJAMIN JACOB CLARK (CRNA) – Certified Registered Nurse Anesthetist, NPI 1407150055
Certified Registered Nurse Anesthetist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for BENJAMIN JACOB CLARK (CRNA)
600 EAST BLVD
ELKHART, IN 465142483
Phone: (574) 523-3193
Type: Location
14660 CARRIGAN CT
GRANGER, IN 465304222
Phone: (574) 523-3193
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $17.
Total Amount is formed as General ($17) + Research ($0) + Ownership ($0) = $17.
Last reported payment date: 2024-01-24 • Largest payer in this snapshot: Acclarent, Inc ($17).
Total Amount
$17
General + Research + Ownership
Payments
1
Total payment records
General Amount
$17
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-01-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Acclarent, Inc | $17 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-12-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20181217002203 | I | Certified Registered Nurse Anesthetist (Crna) | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46514)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| CERTIFIED REGISTERED NURSE ANESTHET | IN | 00790 | Anesthesia for procedure in upper abdomen including use of an endoscope | 11 | 11 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WA | |
| A N E S T H E S I O L O G Y | MS | |
| - | WA | |
| - | FL | |
| - | WA | |
| Certified Registered Nurse Anesthetist (Crna) | AL | |
| A N E S T H E S I O L O G Y | MO | |
| Certified Registered Nurse Anesthetist (Crna) | WA | |
| Certified Registered Nurse Anesthetist (Crna) | WA | |
| A N E S T H E S I O L O G Y | MO |
Reviews
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