NPIMap

Organization Active NPI

Primary Care 360

  • Family Medicine Physician
  • Sherwood, AR
National Provider Identifier
1124678586
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRIMARY CARE 360
Practice address
100 Shadow Oaks Dr
Sherwood, AR 72120-6046
Phone
(501) 486-4045
NPI assigned
Sep 18, 2019
Last updated
Oct 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Authorized official

Name
Dr. Khalid Rayaz, MDNPI 1023107935
Title
Owner
Phone
(501) 833-4001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

100 Shadow Oaks Dr
Sherwood, AR 72120-6046

Mailing address

100 Shadow Oaks Dr
Sherwood, AR 72120-6046
Phone (501) 486-4045

Other practice location 1

300 S Shackleford Rd
Little Rock, AR 72211-5725
Phone (501) 918-9192

Other practice location 2

103 Frankie Ln
White Hall, AR 71602-2685
Phone (870) 393-5050

Other identifiers 1

IdentifierTypeStateIssuer
E-4732OtherARSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200129001002 AR Part B Supplier - Clinic/Group Practice 4183050842 Receives reassigned benefits from 17 practitioners
Practice locations: Sherwood, AR

National Provider Directory

National Provider Directory
Tax ID family
Primary Care 3604 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

300 S Shackleford Rd
Little Rock, AR 72211
Phone (501) 918-0589

103 Frankie Ln
White Hall, AR 71602
Phone (501) 397-2604

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1124678586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SHADOW OAKS DR",
            "city": "SHERWOOD",
            "state": "AR",
            "postal_code": "721206046",
            "telephone_number": "501-486-4045",
            "fax_number": "888-213-5007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SHADOW OAKS DR",
            "city": "SHERWOOD",
            "state": "AR",
            "postal_code": "721206046",
            "telephone_number": "501-486-4045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 S Shackleford Rd",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722115725",
            "country_code": "US",
            "telephone_number": "501-918-9192",
            "fax_number": "501-295-7679",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "103 Frankie Ln",
            "address_purpose": "LOCATION",
            "city": "White Hall",
            "state": "AR",
            "postal_code": "716022685",
            "country_code": "US",
            "telephone_number": "870-393-5050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIMARY CARE 360",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-18",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "RAYAZ",
        "authorized_official_first_name": "KHALID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-833-4001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "E-4732",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sherwood, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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.