Jacey Tanner Guthrie, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

E-11347 Issued in AR

Practice address

4200 N Rodney Parham Rd Ste 202
Little Rock, AR 72212

Phone

(501) 227-4323

Fax

(501) 227-4149

NPI assigned

Apr 14, 2014

Last updated

Oct 14, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Dermatology

Education

Louisiana State University School of Medicine in New Orleans, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arkansas Family Care NetworkGroup PAC ID 0648256800, 30 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Arkansas Family Care Network

  • Family Medicine Physician
  • North Little Rock, AR
  • NPI 1497718134

  Dermatology

  Medicare reassignment Care Compare group NPD
• University of Arkansas for Medical Sciences

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1588654016

  Dermatology

  Medicare reassignment NPD
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD
• Arkansas Family Care Network

  dba Little Rock Family Practice - Central

  • Family Medicine Physician
  • Little Rock, AR
  • NPI 1336396407
  NPD (past)

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1174942528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 N RODNEY PARHAM RD STE 202",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722122460",
            "telephone_number": "501-227-4323",
            "fax_number": "501-227-4149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 N RODNEY PARHAM RD STE 202",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72212",
            "telephone_number": "501-227-4323",
            "fax_number": "501-227-4149"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4018 W Capital Ave",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "72205",
            "country_code": "US",
            "telephone_number": "501-686-5960",
            "fax_number": "501-296-1120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUTHRIE",
        "first_name": "JACEY",
        "middle_name": "TANNER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-14",
        "last_updated": "2021-10-14",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AR",
            "license": "E-11347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hemalraj Gurunathan
• Riesa Gusewelle, APN
• Tracey Jo Gustaveson, RN
• Caleb Logan Guthrey, M.D.
• Florence Guthrie
• Maribel Gutierrez
• Roman Gutkovich, M.D.
• Guy Michael Henry, M.D., P.a. (Grace Clinic For Women)
• Deloris Ann Guy
• Linda Guy, MHPP

• Dermatology Physician in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Dermatology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.