Individual provider Active NPI

Samuel D Taggart, MD

  • Family Medicine Physician
  • Benton, AR
National Provider Identifier
1013098334
Registry record updated Apr 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C4775 Issued in AR
Practice address
3 Medical Park Dr
Suite 100
Benton, AR 72015-3728
Phone
(501) 778-0934
Fax
(501) 778-1013
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C4775 AR Primary

Addresses

Primary practice location

3 Medical Park Dr
Suite 100
Benton, AR 72015-3728

Mailing address

3 Medical Park Dr
Suite 100
Benton, AR 72015-3728
Phone (501) 778-0934

Other identifiers 1

IdentifierTypeStateIssuer
105480001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C4775ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neuroscience Associates PA Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207612800000",
    "number": "1013098334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MEDICAL PARK DR",
            "address_2": "SUITE 100",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153728",
            "telephone_number": "501-778-0934",
            "fax_number": "501-778-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MEDICAL PARK DR",
            "address_2": "SUITE 100",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153728",
            "telephone_number": "501-778-0934",
            "fax_number": "501-778-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAGGART",
        "first_name": "SAMUEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2008-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C4775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105480001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.