NPIMap

Organization Active NPI

Saline Med-Peds Group, Inc

  • Pediatrics Physician
  • Benton, AR
National Provider Identifier
1396820437
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SALINE MED-PEDS GROUP, INC
Practice address
105 McNeil St
Benton, AR 72015-3345
Phone
(501) 315-1222
Fax
(501) 315-1241
NPI assigned
Oct 26, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Mark A Martindale, M.D.NPI 1205911849
Title
Owner
Phone
(501) 315-1222

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

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D0979586Saline Med Peds105 McNeil St, Benton, AR 72015Provider-performed microscopyApr 21, 2028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20041217000112 AR Part B Supplier - Clinic/Group Practice 7517934359 Receives reassigned benefits from 5 practitioners
Practice locations: Benton, AR

National Provider Directory

National Provider Directory

Locations

5 Medical Park Dr
Ste 102A
Benton, AR 72015
Phone (501) 315-1222

Specialties & licenses 7

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X C7310 AR
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X E5062 AR
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X C7310 AR
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X C2718 AR
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

NPPES NPI Registry

Primary practice location

105 McNeil St
Benton, AR 72015-3345

Mailing address

105 McNeil St
Benton, AR 72015-3345
Phone (501) 315-1222

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
161473002MedicaidAR

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 28, 2023.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1396820437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MCNEIL ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153345",
            "telephone_number": "501-315-1222",
            "fax_number": "501-315-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MCNEIL ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153345",
            "telephone_number": "501-315-1222",
            "fax_number": "501-315-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALINE MED-PEDS GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "MARTINDALE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-315-1222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "C7310",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E5062",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "C7310",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": "C2718",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161473002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.