NPIMap

Organization Active NPI

South Arkansas Physician Group LLC

  • Family Medicine Physician
  • El Dorado, AR
National Provider Identifier
1285325969
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SOUTH ARKANSAS PHYSICIAN GROUP LLC
Practice address
620 W Grove St Ste 202
El Dorado, AR 71730-4425
Phone
(870) 863-2000
NPI assigned
May 15, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Authorized official

Name
Brian W Jones
Title
President/Ceo
Phone
(501) 223-2776

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

620 W Grove St Ste 202
El Dorado, AR 71730-4425

Mailing address

2299 Champagnolle Rd
El Dorado, AR 71730-4841
Phone (870) 881-9015

Other practice location 1

700 W Grove St
El Dorado, AR 71730-4416
Phone (870) 863-2000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231120001286 AR Part B Supplier - Clinic/Group Practice 4486002151 Receives reassigned benefits from 11 practitioners
Practice locations: El Dorado, AR

National Provider Directory

National Provider Directory
Tax ID family
South Arkansas Physician Group LLC3 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

620 W Grove St
Ste 200
El Dorado, AR 71730
Phone (870) 864-3352

620 W Grove St
El Dorado, AR 71730
Phone (870) 862-0801

620 W Grove St
Ste 202
El Dorado, AR 71730
Phone (870) 863-2420

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1285325969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2299 CHAMPAGNOLLE RD",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717304841",
            "telephone_number": "870-881-9015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W GROVE ST STE 202",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717304425",
            "telephone_number": "870-863-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 W Grove St",
            "address_purpose": "LOCATION",
            "city": "El Dorado",
            "state": "AR",
            "postal_code": "717304416",
            "country_code": "US",
            "telephone_number": "870-863-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH ARKANSAS PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "501-223-2776"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Dorado, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.