Jacob Clark, - Medicare Physician Assistant in Peoria, IL

Jacob Clark, is a medicare enrolled "Physician Assistant - Medical" in Peoria, Illinois. His current practice location is 530 Ne Glen Oak Ave, Peoria, Illinois. You can reach out to his office (for appointments etc.) via phone at (309) 655-2000.

Jacob Clark is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1013614304.

Contact Information

Jacob Clark,
530 Ne Glen Oak Ave,
Peoria, IL 61637-0001
(309) 655-2000
Not Available



Provider's Profile

Full NameJacob Clark
GenderMale
SpecialityPhysician Assistant - Medical
Location530 Ne Glen Oak Ave, Peoria, Illinois
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1013614304
  • Provider Enumeration Date: 02/08/2023
  • Last Update Date: 04/07/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 2466806401
  • Enrollment ID: I20230926001067

Medical Identifiers

Medical identifiers for Jacob Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1013614304NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363AM0700XPhysician Assistant - Medical (* (Not Available))Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jacob Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jacob Clark,
4537 Tundra Ln,
Mcfarland, WI 53558-9158

Ph: (605) 521-8056
Jacob Clark,
530 Ne Glen Oak Ave,
Peoria, IL 61637-0001

Ph: (309) 655-2000

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› Verified 3 days ago


Physician Assistant Nurses in Peoria, IL

Ms. Courtney M Jaegle, PA
Physician Assistant
Medicare: May Accept Medicare Assignments
Practice Location: 112 Ne Crescent Ave, Peoria, IL 61606
Phone: 309-672-4670    Fax: 309-672-4669
Natalie Patty,
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 5111 N Glen Park Place Rd, Peoria, IL 61614
Phone: 309-683-5700    
Rob Wimmer, P.A.
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 7309 N Knoxville Ave, Peoria, IL 61614
Phone: 309-692-9898    
Benjamin Richard Tellier, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 723 Ne Glen Oak Ave, Peoria, IL 61603
Phone: 309-624-8749    Fax: 309-624-8870
Abigail Rose Sutton, PA-C
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 303 N William Kumpf Blvd, Peoria, IL 61605
Phone: 309-676-5546    Fax: 309-676-5045
Richard S Seaboch, PA
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 5405 N Knoxville Ave, Peoria, IL 61614
Phone: 309-691-4410    Fax: 309-589-2830

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