Individual provider Active NPI

Lori Bacon, M.D.

  • Emergency Medicine Physician
  • North Little Rock, AR
National Provider Identifier
1073612883
Registry record updated May 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
E2154 Issued in AR
Practice address
3333 Springhill Dr
North Little Rock, AR 72117-2922
Phone
(501) 202-6800
NPI assigned
Sep 21, 2006
Last updated
May 19, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X E2154 AR Primary

Addresses

Primary practice location

3333 Springhill Dr
North Little Rock, AR 72117-2922

Mailing address

11001 Executive Center Dr
Ste. 200
Little Rock, AR 72211-4316
Phone (501) 812-7589

Other identifiers 1

IdentifierTypeStateIssuer
140205001MedicaidAR

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
I20100323000489 AR Practitioner - Emergency MedicinePractitioner - Family Practice 8022143502 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Arkansas College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greenbrier Emergency Services, Inc.Group PAC ID 2668377359, 53 clinicians

Practice addresses (Care Compare)

3333 Springhill Dr
North Little Rock, AR 72117-2922
Phone (501) 202-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E2154ARMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Health Group CurrentSince Nov 1, 2000 Accepting new patients
Greenbrier Emergency Services, Inc. Emergency Medicine CurrentSince Nov 1, 2019 Accepting new patients
Arkansas Health Group CurrentSince Nov 1, 2000 Accepting new patients

Locations

11001 Executive Center Dr
Ste 200
Little Rock, AR 72211
Phone (501) 812-7215

2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680

3333 Springhill Dr
North Little Rock, AR 72117
Phone (501) 202-3000

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211155200000",
    "number": "1073612883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DR",
            "address_2": "STE. 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114316",
            "telephone_number": "501-812-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 SPRINGHILL DR",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721172922",
            "telephone_number": "501-202-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "LORI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E2154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140205001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Little Rock, AR

Sources for this page

Verify at the official NPI Registry.