Individual provider Active NPI

Rick Wayne Harrison, MD

  • Pediatrics Physician
  • Russellville, AR
National Provider Identifier
1316903669
Registry record updated Feb 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
C-6833 Issued in AR
Practice address
101 Skyline Dr
Russellville, AR 72801-3363
Phone
(479) 968-2345
Fax
(479) 890-7169
NPI assigned
Apr 25, 2006
Last updated
Feb 18, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X C-6833 AR Primary

Addresses

Primary practice location

101 Skyline Dr
Russellville, AR 72801-3363

Mailing address

101 Skyline Dr
Russellville, AR 72801-3363
Phone (479) 968-2345

Other identifiers 1

IdentifierTypeStateIssuer
114304001MedicaidAR

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080611000182 AR Practitioner - Pediatric Medicine 6103819115 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C-6833ARMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Marys Physician Services, LLC CurrentSince Dec 1, 2003 Accepting new patients
St Mary's Physician Services LLC CurrentSince Dec 1, 2003 Accepting new patients
St Marys Physician Services, LLC Past Accepting new patients

Locations

101 Skyline Dr
Russellville, AR 72801
Phone (479) 968-2345

Organizations & group practices 3

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": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424217600000",
    "number": "1316903669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SKYLINE DR",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013363",
            "telephone_number": "479-968-2345",
            "fax_number": "479-890-7169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SKYLINE DR",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013363",
            "telephone_number": "479-968-2345",
            "fax_number": "479-890-7169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "RICK",
        "middle_name": "WAYNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2015-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "C-6833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114304001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

Verify at the official NPI Registry.