NPIMap

Organization Active NPI

Northwest Dermatology Clinic, P.a.

  • Dermatopathology Physician
  • Springdale, AR
National Provider Identifier
1366490997
Registry record updated Jan 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
MC1781 Issued in AR
Legal business name
NORTHWEST DERMATOLOGY CLINIC, P.A.
Practice address
5100 S Thompson St # 212
Springdale, AR 72764-6933
Phone
(479) 750-7200
Fax
(479) 750-7202
NPI assigned
May 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2010

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

Authorized official

Name
James R Wharton, M.D.NPI 1386619203
Title
President
Phone
(479) 750-7200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X MC1781 AR
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X MC1781 AR
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X MC1781 AR Primary
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X MC1781 AR

Addresses

Primary practice location

5100 S Thompson St # 212
Springdale, AR 72764-6933

Mailing address

5100 S Thompson St # 212
Springdale, AR 72764-6933
Phone (479) 750-7200

Other identifiers 1

IdentifierTypeStateIssuer
133978002MedicaidAR

National Provider Directory

National Provider Directory

Locations

5100 S Thompson St
Ste 212
Springdale, AR 72764
Phone (479) 750-7200

Practitioners & affiliated clinicians

Practitioners 6

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": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262736000000",
    "number": "1366490997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 S THOMPSON ST # 212",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727646933",
            "telephone_number": "479-750-7200",
            "fax_number": "479-750-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 S THOMPSON ST # 212",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727646933",
            "telephone_number": "479-750-7200",
            "fax_number": "479-750-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST DERMATOLOGY CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2010-01-06",
        "status": "A",
        "authorized_official_last_name": "WHARTON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-750-7200",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "AR",
            "license": "MC1781",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AR",
            "license": "MC1781",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "AR",
            "license": "MC1781",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AR",
            "license": "MC1781",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133978002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springdale, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.