Active NPI
Kenneth L Ubben, M.D.
- Specialist
- Bella Vista, AR
National Provider Identifier
1326099136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- C-8212
- Practice address
- 5 Cunningham Cor
Bella Vista, AR 72714-3520 - Phone
- (479) 855-1247
- Fax
- (479) 855-1249
- NPI assigned
- May 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | C-8212 | AR | Primary |
Addresses
Primary practice location
5 Cunningham Cor
Bella Vista, AR 72714-3520
Mailing address
5 Cunningham Cor
Bella Vista, AR 72714-3520
Phone (479) 855-1247
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122172001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-8212 | AR | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Dermatology & Skin Renewal Center | Past | Accepting new patients | |
| Physical Medicine & Rehabilitation Associates of NW Ar PA | Past | Accepting new patients | |
| True Dermatology PLLC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Rehabilitation Practitioner
- Rogers, AR
- NPI 1174777874
-
- Clinical & Laboratory Dermatological Immunology Physician
- Bentonville, AR
- NPI 1912912361
-
- Dermatology Physician
- Fayetteville, AR
- NPI 1386022283
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1326099136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 CUNNINGHAM COR",
"city": "BELLA VISTA",
"state": "AR",
"postal_code": "727143520",
"telephone_number": "479-855-1247",
"fax_number": "479-855-1249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 CUNNINGHAM COR",
"city": "BELLA VISTA",
"state": "AR",
"postal_code": "727143520",
"telephone_number": "479-855-1247",
"fax_number": "479-855-1249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UBBEN",
"first_name": "KENNETH",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-15",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AR",
"license": "C-8212",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "122172001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bella Vista, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.