Active NPI
Dac Tat Pham, M.D.
- Family Medicine Physician
- Brinkley, AR
National Provider Identifier
1063409761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R3398
- Practice address
- 208 S Main Ave
Brinkley, AR 72021-3210 - Phone
- (870) 734-3222
- Fax
- (870) 734-1341
- NPI assigned
- Sep 29, 2005
- Last updated
- Apr 4, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R3398 | AR | Primary |
Addresses
Primary practice location
208 S Main Ave
Brinkley, AR 72021-3210
Mailing address
208 S Main Ave
Brinkley, AR 72021-3210
Phone (870) 734-3222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103572001 | Medicaid | AR |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100210000732 | AR | Practitioner - Family Practice | 6507909702 | Practice locations: Brinkley, AR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R3398 | AR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333497600000",
"number": "1063409761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 S MAIN AVE",
"city": "BRINKLEY",
"state": "AR",
"postal_code": "720213210",
"telephone_number": "870-734-3222",
"fax_number": "870-734-1341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 S MAIN AVE",
"city": "BRINKLEY",
"state": "AR",
"postal_code": "720213210",
"telephone_number": "870-734-3222",
"fax_number": "870-734-1341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "DAC",
"middle_name": "TAT",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-29",
"last_updated": "2012-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AR",
"license": "R3398",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103572001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brinkley, AR
- Andrew Neaville, PHARMD
- Northeast Arkansas Community Mental Health Center Inc (Mid-South Health Systems)
- Odyssey Healthcare Operating a, LP (Gentiva)
- Carl Norvin Overcash, DDS
- Colby Petty
- Michael Sayger, DPT
- Simmons Eye Center
- Johnathan Clyde Simpson, LCSW
- Southern Lifecare Emergency Medical Services, Inc.
- Southern Paramedic Service Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; 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.