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

Mr. Dylan Ross Clark, STUDENT

Individual provider Certified Registered Nurse Anesthetist · NPI 1104530930

Mr. Dylan Ross Clark, STUDENT is a Certified Registered Nurse Anesthetist (CRNA) in Boston, Massachusetts. Qualified in 2025, 1 year ago. Practices with Boston University Medical Center Anesthesiologists Inc, a 87-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Massachusetts.

Years since qualifying
1
Licensed in
MA
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

1 Boston Medical Center Pl
Boston, MA 02118
Phone: (617) 638-6950
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 140 Commonwealth Ave, Chestnut Hill, MA 02467-3858 — (617) 552-2756

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence RN2287470 (MA)
Registered Nurse Taxonomy 163W00000X · Licence RN2287470 (MA)

Record details

NPI number1104530930
Entity typeIndividual (Type 1)
GenderMale
Credentials STUDENT
Sole proprietorYes
NPI enumeratedJanuary 6, 2023
Last updated in NPPESApril 2, 2026
Certification dateApril 2, 2026
Mailing address960 Massachusetts Ave, Flr 2, Boston, MA 02118

Medicare enrollment

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

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Boston University Medical Center Anesthesiologists Inc — 87 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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