Active NPI
Jeff Pattermann, PD
- Pharmacist
- Clarksville, AR
National Provider Identifier
1154923894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD06178
- Practice address
- 230 E Market St
Clarksville, AR 72830-9069 - Phone
- (479) 754-6169
- Fax
- (479) 754-6419
- NPI assigned
- Nov 9, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD06178 | AR | Primary |
Addresses
Primary practice location
230 E Market St
Clarksville, AR 72830-9069
Mailing address
PO Box 10116
Russellville, AR 72812-0116
Phone (479) 886-1143
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD06178 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1154923894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10116",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728120116",
"telephone_number": "479-886-1143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 E MARKET ST",
"city": "CLARKSVILLE",
"state": "AR",
"postal_code": "728309069",
"telephone_number": "479-754-6169",
"fax_number": "479-754-6419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTERMANN",
"first_name": "JEFF",
"credential": "PD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-09",
"last_updated": "2020-11-09",
"certification_date": "2020-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD06178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.