Matthew Self, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E-5282 Issued in AR

Practice address

200 N 3Rd St
Dardanelle, AR 72834-3802

Phone

(479) 229-2827

Fax

(479) 229-6167

NPI assigned

Apr 3, 2007

Last updated

Jan 11, 2008By the provider in NPPES

Sex

Male

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200009600000",
    "number": "1306967377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 LARKSPUR CT",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728026913",
            "telephone_number": "479-967-3009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N 3RD ST",
            "city": "DARDANELLE",
            "state": "AR",
            "postal_code": "728343802",
            "telephone_number": "479-229-2827",
            "fax_number": "479-229-6167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-5282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaci Rood, PHARM D
• Rose Drug of Dover, Inc (Berry Drug of Dardanelle)
• Rose Drug of Dover, Inc (Berry Drug of Dardanelle)
• William Patrick Scott, MD
• SDS Emergency Staffing LLC
• Jill M Sheets, P.D.
• Tanna Shockley, APRN
• Charles Burrell Smith Jr., D.C.
• Annette Kay Snider, LCSW
• State of Arkansas (Yell County Health Unit Dardanelle)

• Family Medicine Physician in Dardanelle, AR
• Providers in Dardanelle, 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 11, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.