Arkansas Children'S Medical Group PLLC
Organization Active NPI Pediatrics Physician · Little Rock, AR
NPI 1396274841 · NPPES record last updated Jul 7, 2022
Key facts
- NPI
- 1396274841
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- ARKANSAS CHILDREN'S MEDICAL GROUP PLLC
- Practice address
- 1 Childrens Way # 844
Little Rock, AR 72202-3500 - Phone
- (501) 364-2090
- Fax
- (501) 364-3929
- NPI assigned
- Jun 8, 2017
- Organization subpart
- No
Authorized official
- Name
- Mr. Robert S Williams, MD
- Title
- President
- Phone
- (501) 364-2090
Subparts reporting this organization as parent 2
Corporate family (same tax ID) 2
Practitioners 68
-
Robert S. Williams, M.D.
-
Holli Beth Bagwell, D.O.
-
Stephen James Canon, M.D.
-
Christina Nicole Dalton, D.O.
-
Gregory M Dupuis, MD
-
Taira Nicole Garrett, CNP
-
Blake Gruenberg, MD
-
Sarah Ann Guntorius, APRN-CNP
-
Heather Johnson, APRN
-
Jyh-I James Lu, M.D.
-
Joana Marie Mack, M.D.
-
Rachel A McKelvy, M.D.
-
Megan Renee Merrigan, PNP
-
Ashay Patel, D.O.
-
Sally Dee Puckett, APRN
-
Amanda Schafer Quick, APRN-CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171010002445 | AR | Part B Supplier - Clinic/Group Practice | 7719252139 |
Receives reassigned benefits from 36 practitioners Practice locations: Little Rock, AR; Pine Bluff, AR; Rogers, AR; Springdale, AR |
National Provider Directory
- Tax ID family
- Arkansas Childrens Medical
Locations
1 Childrens Way
#844
Little Rock, AR 72202
Phone (501) 364-2090
302 E Roosevelt Rd
Little Rock, AR 72206
1500 W 42nd Ave
Pine Bluff, AR 71603
Phone (501) 364-2090
900 S 52nd St
Rogers, AR 72758
Phone (501) 364-2090
2575 Gene George Blvd
Ste 400
Springdale, AR 72762
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Pediatric Emergency Medicine (Pediatrics) Physician |
2080P0204X | |||
| Pediatric Endocrinology Physician |
2080P0205X | |||
| Pediatric Hematology & Oncology Physician |
2080P0207X |
Addresses
Primary practice location
1 Childrens Way # 844
Little Rock, AR 72202-3500
Mailing address
1 Childrens Way # 844
Little Rock, AR 72202-3500
Phone (501) 364-2090
Other practice location 1
2601 Gene George Blvd
Springdale, AR 72762-0845
Phone (479) 725-6801
Other practice location 2
1500 W 42nd Ave
Pine Bluff, AR 71603-7018
Phone (870) 341-5820
Other practice location 3
900 S 52nd St
Rogers, AR 72758-8637
Phone (479) 254-1100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5E311 | Other | AR | BLUE CROSS AND BLUE SHIELD |
| 222588002 | Medicaid | AR |
Other providers in Little Rock, AR
- Arkansas Children'S Hospital
- Arkansas Children'S Hospital
- Arkansas Children'S Hospital
- Arkansas Children'S Hospital
- Arkansas Children'S Hospital
- Arkansas Children'S Medical Group, PLLC
- Arkansas Childrens Hospital
- Arkansas Childrens Hospital
- Arkansas Childrens Hospital
- Arkansas Childrens Hospital
All providers in Little Rock, AR · Pediatrics Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.