Mervin Dale Terrell, M.D.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

E3820 Issued in AR

Practice address

1220 W 42ND Ave
Pine Bluff, AR 71603-7109

Phone

(870) 541-0013

Fax

(870) 541-0014

NPI assigned

Aug 17, 2005

Last updated

Mar 13, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Jefferson Hospital Association Inc

  dba Jefferson Regional Medical Center

  • General Acute Care Hospital
  • Pine Bluff, AR
  • NPI 1710931985
  Medicare reassignment NPD
• Jefferson Hospital Association, Inc

  • Rural Health Clinic/Center
  • Crossett, AR
  • NPI 1225799646
  NPD

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489363200000",
    "number": "1043202856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 W 42ND AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037109",
            "telephone_number": "870-541-0013",
            "fax_number": "870-541-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 W 42ND AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037109",
            "telephone_number": "870-541-0013",
            "fax_number": "870-541-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERRELL",
        "first_name": "MERVIN",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2017-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "AR",
            "license": "E3820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150188001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5M697",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie R Taylor
• Humphrey Tayong Tekum
• J. Greg Temple, DDS
• Joshua Tennyson
• Letera Kassahun Terefasa, MD
• The Gardens at Whispering Knoll
• The Oasis of Pine Bluff, LLC
• The P.a.T. (People Advocating Transition) Center (The P.A.T. Center: People Advocating Transition)
• The P.a.T. Center
• The Pat Center

• Geriatric Medicine (Internal Medicine) Physician in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Geriatric Medicine (Internal Medicine) Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.