North Little Rock Primary Care and Diagnostic Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NORTH LITTLE ROCK PRIMARY CARE AND DIAGNOSTIC CLINIC PLLC

Practice address

400 W Pershing Blvd
N Little Rock, AR 72114-2146

Phone

(501) 771-7717

Fax

(501) 771-0550

NPI assigned

Jul 6, 2006

Last updated

Jan 3, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Derek Lewis, MDNPI 1407810641

Title

President

Phone

(501) 771-7717

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 5

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.

• Derek Lewis, M.D.

  • Family Medicine Physician
  • Little Rock, AR
  • NPI 1407810641
  Medicare reassignment Care Compare group NPD Authorized official
• Rose Marie Shaw-Bullock, M.D.

  • Family Medicine Physician
  • N Little Rock, AR
  • NPI 1790749943
  Medicare reassignment Care Compare group NPD
• Vincent Tyrone Morgan, APRN

  • Adult Health Nurse Practitioner
  • Little Rock, AR
  • NPI 1235770942
  NPD
• Latonya Harris

  • Family Nurse Practitioner
  • North Little Rock, AR
  • NPI 1528224508
  NPD (past)
• Ariel Elizabeth Rohde, PA

  • Physician Assistant
  • North Little Rock, AR
  • NPI 1740768944
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483401600000",
    "number": "1306877576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W PERSHING BLVD",
            "city": "N LITTLE ROCK",
            "state": "AR",
            "postal_code": "721142146",
            "telephone_number": "501-771-7717",
            "fax_number": "501-771-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W PERSHING BLVD",
            "city": "N LITTLE ROCK",
            "state": "AR",
            "postal_code": "721142146",
            "telephone_number": "501-771-7717",
            "fax_number": "501-771-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH LITTLE ROCK PRIMARY CARE AND DIAGNOSTIC CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2017-01-03",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-771-7717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133705002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5B979",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karla Leann Morris
• Jason Randall Mounts, DMD
• Muhammad Ali Siddiqui, MD PA (Lakewood Family Medicine Clinic)
• Nash Therapeutic Services, LLC
• North Little Rock Pet Associates, LLC (Central Ar Pet)
• North LR Medical Imaging LLC
• Van S O'Dell, DDS
• Stephanie Rebekah Oldham, MS, OTR/L
• Anthony P Owen, PHARMD
• Pain & Ortho Products, LLC

• Family Medicine Physician in N Little Rock, AR
• Providers in N Little Rock, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; 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.