KILMENY CLARK – Physician Assistant, NPI 1104443258
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for KILMENY CLARK
S67W17809 COPPER OAKS CT
MUSKEGO, WI 531507503
Phone:
Type: Mailing
300 W OAK ST
CARBONDALE, IL 629011400
Phone: (618) 453-8850
Type: Location
611 W PARK ST
FAPC
URBANA, IL 618012500
Phone:
Type: Mailing
3024 E EMPIRE ST
BLOOMINGTON, IL 617045402
Phone: (309) 556-7556
Fax: (309) 556-7551
Type: Location
300 W Oak St
Carbondale, IL 629011400
Phone: (618) 453-8850
Type: Location
1800 E LAKE SHORE DR
DECATUR, IL 625213810
Phone: (217) 464-2973
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2021-04-30
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 |
|---|---|---|---|---|
| I20210430000042 | I | Physician Assistant | IL | 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 |
|---|---|---|---|---|
| 99284 | Emergency department visit with moderate level of medical decision making | 59 | 59 | $0 |
| 99283 | Emergency department visit with low level of medical decision making | 29 | 29 | $0 |
| 99285 | Emergency department visit with high level of medical decision making | 25 | 25 | $0 |
| 99282 | Emergency department visit with straightforward medical decision making | 11 | 11 | $0 |
Insurance plans in this area (ZIP 53150)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IL | |
| Clinical Psychologist | IL | |
| Hospitalist, Family Practice | TX | |
| Clinical Psychologist | IL | |
| Cardiovascular Disease (Cardiology) | IL | |
| Cardiovascular Disease (Cardiology) | IL | |
| - | IL | |
| Diagnostic Radiology | IL | |
| Physician Assistant | IL | |
| Physician Assistant | IL |
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