NPIMap

Individual provider Active NPI

R Keith Davis Jr., M.D.

  • Family Medicine Physician
  • Smackover, AR
National Provider Identifier
1104826320
Registry record updated Feb 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E3055 Issued in AR
Practice address
1400 Pershing Hwy
Smackover, AR 71762-2300
Phone
(870) 725-3471
Fax
(870) 725-3215
NPI assigned
Jul 29, 2005
Last updated
Feb 21, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E3055 AR Primary

Addresses

Primary practice location

1400 Pershing Hwy
Smackover, AR 71762-2300

Mailing address

PO Box 69
Smackover, AR 71762-0069
Phone (870) 725-3471

Other identifiers 3

IdentifierTypeStateIssuer
5M036OtherARBCBS
145479001MedicaidAR
A002OtherARTRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040220000216 AR Practitioner - Family Practice 8224923966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1400 Pershing Hwy
Smackover, AR 71762-2300
Phone (870) 725-3471

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
29.48 of 100Reported as individual
Quality
15
Improvement activities
0
Cost
78.28

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions84
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Richard K Davis MD PLLC PA Family Medicine Current Accepting new patients
R Keith Davis MD PLLC PA Family Medicine Current Accepting new patients
R Keith Davis MD PLLC PA Family Medicine CurrentSince Aug 24, 2009 Accepting new patients
Clint a Netherland, MD, PLLC Family Medicine Current Accepting new patients
South Arkansas Physician Services LLC Family Medicine Past Accepting new patients

Locations

1400 Pershing Hwy
Smackover, AR 71762
Phone (870) 725-3471

Organizations & group practices 5

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 4

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": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361404800000",
    "number": "1104826320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "city": "SMACKOVER",
            "state": "AR",
            "postal_code": "717620069",
            "telephone_number": "870-725-3471",
            "fax_number": "870-725-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PERSHING HWY",
            "city": "SMACKOVER",
            "state": "AR",
            "postal_code": "717622300",
            "telephone_number": "870-725-3471",
            "fax_number": "870-725-3215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "R",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2013-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E3055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5M036",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145479001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smackover, AR

Sources for this page

Verify at the official NPI Registry.