Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacob Clark

Individual provider Medical Physician Assistant · NPI 1013614304

Jacob Clark is a Physician Assistant in Peoria, Illinois. Graduated from Yale University School of Medicine in 2023, 3 years ago. Practices with Osf Multi-Specialty Group, a 2,128-clinician group and accepts Medicare assignment.

Years since qualifying
3
Trained at
Yale University School of Medicine
In the registry since
2023

Practice location Address checks out

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone: (309) 655-2000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X

Record details

NPI number1013614304
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 8, 2023
Last updated in NPPESApril 7, 2023
Certification dateApril 7, 2023
Mailing address4537 Tundra Ln, McFarland, WI 53558-9158

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolYALE UNIVERSITY SCHOOL OF MEDICINE
Graduated 2023 (3 years in practice)
Group practice Osf Multi-Specialty Group — 2128 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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