Individual provider Active NPI

David James Pennington, M.D.

  • Pediatrics Physician
  • Arkadelphia, AR
National Provider Identifier
1023540275
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
E-11949 Issued in AR
Practice address
2850 Twin Rivers Dr # 102
Arkadelphia, AR 71923-4212
Phone
(870) 246-8036
NPI assigned
Mar 28, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X E-11949 AR Primary

Addresses

Primary practice location

2850 Twin Rivers Dr # 102
Arkadelphia, AR 71923-4212

Mailing address

2850 Twin Rivers Dr # 102
Arkadelphia, AR 71923-4212
Phone (870) 246-8036

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170612002555 AR Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 9537437744

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-11949ARMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Coverage Solutions PLLC Single Specialty Current Accepting new patients
Arkadelphia Clinic for Children and Young Adults, PA Single Specialty Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HJABAA/Endpoint/HJABAA

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Arkadelphia Clinic for Children and Young Adults, PAArkadelphia, AR, CCN 043904 Rural health clinic 5% Or Greater Direct Ownership Interest (10%)
Corporate Officer
Corporate Director
W-2 Managing Employee
Jan 1, 2024
Jan 1, 2024
Jan 1, 2024
Jan 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1023540275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 TWIN RIVERS DR # 102",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719234212",
            "telephone_number": "870-246-8036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 TWIN RIVERS DR # 102",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719234212",
            "telephone_number": "870-246-8036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNINGTON",
        "first_name": "DAVID",
        "middle_name": "JAMES",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-28",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-11949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arkadelphia, AR

Sources for this page

Verify at the official NPI Registry.