David John Tucker, MD
Individual provider Active NPI Family Medicine Physician · Gravette, AR
NPI 1023076619 · NPPES record last updated Oct 16, 2023
Key facts
- NPI
- 1023076619
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- R3698 (AR)
- Practice address
- 1101 Jackson St SW
Gravette, AR 72736-9121 - Phone
- (479) 787-5221
- Fax
- (479) 787-5613
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Michigan Medical School, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sgoh Acquisition Inc
Practice addresses (Care Compare)
1101 Jackson St SW
Gravette, AR 72736-9121
Phone (479) 787-5291
125 Main St
Noel, MO 64854-9124
Phone (417) 475-6151
Hospital & facility affiliations
- Elite Home Health
- Mercy Home Health
- Elite Hospice
- Circle of Life Hospice
- Ozarks Community Hospital of Gravette
- Mercy Hospital Northwest Arkansas
- Siloam Springs Regional Hospital
- Mercy Hospital Joplin
- Siloam Healthcare, LLC
- Ozarks Community Hospital of Gravette
- Concordia Nursing & Rehab, LLC
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 1-10 |
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR, MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040129001098 | AR | Practitioner - Family Practice | 8022911726 | Reassigns benefits to 3 organizations |
| I20140929000269 | MO | Practitioner - Family Practice | 8022911726 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R3698 | AR | MD | Family Medicine Physician |
| 2013042315 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sgoh Acquisition Inc | Current |
Accepting new patients | |
| Primrose Nephrology, Inc. | Current | Accepting new patients | |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
| Mercy Health Northwest Arkansas Communities | Past | Accepting new patients |
Locations
1101 Jackson St SW
Gravette, AR 72736
Phone (479) 787-5221
1540 E Evergreen St
Springfield, MO 65803
Phone (417) 823-2900
Interoperability endpoints
- dtucker@ochhospital.hin.us
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2013042315 | MO | |
| Family Medicine Physician | 207Q00000X | R3698 | AR | Yes |
Addresses
Primary practice location
1101 Jackson St SW
Gravette, AR 72736-9121
Mailing address
1101 Jackson St SW
Gravette, AR 72736-9121
Phone (479) 787-5221
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112423001 | Medicaid | AR | |
| 50654 | Other | AR | AR BCBS |
| 100726240D | Other | OK | OK MEDICAID GROUP NUMBER |
| 100061170A | Medicaid | OK | |
| 202310207 | Medicaid | MO | |
| P00144854 | Other | AR | RAILROAD MEDICARE NUMBER |
| P00894372 | Other | AR | OCH RR MEDICARE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | DTUCKER@OCHHOSPITAL.HIN.US |
Other providers in Gravette, AR
- Marva Shockley
- Lloyd Layton Spencer
- Kenneth C. Stewart
- Teasley Drug Inc
- Donald Tribbey
- Uplift, LLC
- Molly Claire Vaughan
- Wal-Mart Stores Inc
- Melody A Walls
- Lindsey S Watford
All providers in Gravette, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.