CLARK KELLOGG – Anesthesiologist Assistant, NPI 1457098154
Anesthesiologist Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
424 ANESTHESIOLOGY ASSISTANT in OH
Provider Addresses for CLARK KELLOGG
335 GLESSNER AVE
MANSFIELD, OH 449032269
Phone: (419) 526-8000
Type: Location
5910 BLUESTONE WAY
LEWIS CENTER, OH 430357550
Phone: (614) 301-2639
Type: Mailing
799 LEXINGTON AVE
MANSFIELD, OH 449071906
Phone: (419) 756-5133
Fax: (419) 774-9707
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 6 Open Payments records for all available years, with a total value of $119.
Total Amount is formed as General ($119) + Research ($0) + Ownership ($0) = $119.
Last reported payment date: 2024-11-13 • Largest payer in this snapshot: Mindray DS USA, Inc. ($68).
Total Amount
$119
General + Research + Ownership
Payments
6
Total payment records
General Amount
$119
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Mindray DS USA, Inc. | $68 |
| Merck Sharp & Dohme LLC | $33 |
| KARL STORZ Endoscopy-America | $18 |
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: 2023-01-03
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 |
|---|---|---|---|---|
| I20230103002254 | I | Anesthesiology Assistant | OH | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 00731 | Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope | 16 | 16 | $0 |
Insurance plans in this area (ZIP 44903)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| A N E S T H E S I O L O G Y | OH | |
| A N E S T H E S I O L O G Y | KY | |
| Anesthesiology Assistant | OH | |
| A N E S T H E S I O L O G Y | OH | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| Anesthesiology Assistant | OH | |
| Certified Registered Nurse Anesthetist (Crna) | OH |
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