Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Elijah Boone Clark, PA-C

Individual provider Medical Physician Assistant · NPI 1962128595

Elijah Boone Clark, PA-C is a Physician Assistant in Chicago, Illinois. Qualified in 2022, 4 years ago. Practices with Cardiac Surgery Associates SC, a 45-clinician group and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2022
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

675 N Saint Clair St Ste 19-100
Chicago, IL 60611-5969
Phone: (312) 664-3278
Fax: (312) 695-5774
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Medical Physician Assistant Taxonomy 363AM0700X
Surgical Physician Assistant Taxonomy 363AS0400X

Record details

NPI number1962128595
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 14, 2022
Last updated in NPPESJuly 29, 2024
Certification dateJuly 29, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Cardiac Surgery Associates Sc — 45 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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