Eric Kamaal Mathis, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2880 Issued in AR

Practice address

26 Green Valley Dr
Mountain Home, AR 72653-8102

Phone

(870) 425-6911

Fax

(870) 424-4891

NPI assigned

Oct 27, 2006

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Eric K. Mathis, DDS

  • Dental Clinic/Center
  • Mountain Home, AR
  • NPI 1639771827
  NPD

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043396823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 GREEN VALLEY DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726538102",
            "telephone_number": "870-425-6911",
            "fax_number": "870-424-4891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 GREEN VALLEY DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726538102",
            "telephone_number": "870-425-6911",
            "fax_number": "870-424-4891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "ERIC",
        "middle_name": "KAMAAL",
        "name_prefix": "Mr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "2880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "58313",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "842508",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Wren OB/GYN, PLLC
• Jordan Claire Massie
• Harold Masterson, PSYEX
• Jordan Lucus Masterson, LCSW
• Grant Mathews, MD
• Fonda Kay Maupin, MHP
• Emily Maxon
• Maxus Inc.
• Aaron May, CRNA
• Lara A. May, DNP, APRN, NP-C

• General Practice Dentistry in Mountain Home, AR
• Providers in Mountain Home, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.