NPIMap

Organization Active NPI

Physician Group of Arkansas, Inc.

  • Specialist
  • Hope, AR
National Provider Identifier
1093060824
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PHYSICIAN GROUP OF ARKANSAS, INC.
Practice address
2001 S Main St
Hope, AR 71801-8124
Phone
(870) 777-2323
Fax
(870) 722-7158
NPI assigned
Jul 18, 2012
Last updated
Mar 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Authorized official

Name
Jonathan A Demke
Title
Ceo
Phone
(615) 467-1072

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

2001 S Main St
Hope, AR 71801-8124

Mailing address

PO Box 842109
Dallas, TX 75284-2109
Phone (866) 286-2802

Other identifiers 1

IdentifierTypeStateIssuer
196268002MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121004000562 AR Part B Supplier - Clinic/Group Practice 0941459010 Receives reassigned benefits from 8 practitioners
Practice locations: Hope, AR

National Provider Directory

National Provider Directory
Tax ID family
Physician Group of Arkansas Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2001 S Main St
#100
Hope, AR 71801

302 Bill Clinton Dr
Ste B
Hope, AR 71801
Phone (870) 722-5011

405 W 16th St
#B
Hope, AR 71801
Phone (573) 429-4799

1900 N 7th St
West Monroe, LA 71291
Phone (318) 322-8535

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1093060824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842109",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752842109",
            "telephone_number": "866-286-2802",
            "fax_number": "314-432-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S MAIN ST",
            "city": "HOPE",
            "state": "AR",
            "postal_code": "718018124",
            "telephone_number": "870-777-2323",
            "fax_number": "870-722-7158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN GROUP OF ARKANSAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-18",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "DEMKE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-467-1072"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196268002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hope, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; 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.