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

Jimmy Clark Jr., PA-C

Individual provider Physician Assistant · NPI 1891164372

Jimmy Clark Jr., PA-C is a Physician Assistant in Madison, Wisconsin. Qualified in 2015, 11 years ago. Practices with Stoughton Hospital Association, a 66-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
11
Licensed in
WI
In the registry since
2015
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

5512 Spring Tide Way
Madison, WI 53718-9125
Phone: (224) 848-0612
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 3614 (WI)

Record details

NPI number1891164372
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 15, 2015
Last updated in NPPESJune 9, 2026
Certification dateJune 9, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Stoughton Hospital Association — 66 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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