NPIMap

Organization Active NPI

Clarksville Medical Group, P.a.

  • Clinical Medical Laboratory
  • Clarksville, AR
National Provider Identifier
1417009374
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
MC0283 Issued in AR
Legal business name
CLARKSVILLE MEDICAL GROUP, P.A.
Practice address
601 W McKennon St
Clarksville, AR 72830-3523
Phone
(479) 754-8384
Fax
(479) 754-7141
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Leanna J Perrett
Title
Office Manager
Phone
(479) 754-8384

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X MC0283 AR Primary

Addresses

Primary practice location

601 W McKennon St
Clarksville, AR 72830-3523

Mailing address

PO Box 668
Clarksville, AR 72830-0668
Phone (479) 754-8384

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
04D0469031Clarksville Medical Group, PA601 W McKennon St, Clarksville, AR 72830ComplianceDec 9, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IEFHAA
  • FHIR API: https://api.platform.athenahealth.com/7504/brand/1/csg/1/fhir/r4

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": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417009374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 668",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728300668",
            "telephone_number": "479-754-8384",
            "fax_number": "479-754-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W MCKENNON ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303523",
            "telephone_number": "479-754-8384",
            "fax_number": "479-754-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE MEDICAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PERRETT",
        "authorized_official_first_name": "LEANNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "479-754-8384"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AR",
            "license": "MC0283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.