NPIMap

Individual provider Active NPI

Omar Yacob

  • Interventional Cardiology Physician
  • Conway, AR
National Provider Identifier
1417442369
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
E-19041 Issued in AR
Practice address
625 United Dr Ste 220
Conway, AR 72032-7835
Phone
(501) 358-6361
Fax
(501) 358-6714
NPI assigned
Jun 23, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E-19041 AR
Interventional Cardiology Physician 207RI0011X E-19041 AR Primary

Addresses

Primary practice location

625 United Dr Ste 220
Conway, AR 72032-7835

Mailing address

11001 Executive Center Dr Ste 200
Little Rock, AR 72211-4393
Phone (501) 358-6361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250618003574 AR Practitioner - Interventional Cardiology 0648672451 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist HealthGroup PAC ID 0648177949, 106 clinicians

Practice addresses (Care Compare)

625 United Dr
Suite 220
Conway, AR 72032-7826
Phone (501) 358-6361

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Current Accepting new patients
Baptist Health CurrentSince Aug 1, 2025 Accepting new patients
Baptist Health CurrentSince Aug 1, 2025 Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients

Locations

625 United Dr
Ste 220
Conway, AR 72032
Phone (501) 327-7555

11001 Executive Center Dr
Ste 200
Little Rock, AR 72211
Phone (501) 812-7215

9501 Baptist Health Dr
Ste 600
Little Rock, AR 72205

Interoperability endpoints

  • Direct secure messaging: oyacob804068@direct.baptist-healthar.org

Organizations & group practices 4

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1417442369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DR STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114393",
            "telephone_number": "501-358-6361",
            "fax_number": "501-358-6714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 UNITED DR STE 220",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720327835",
            "telephone_number": "501-358-6361",
            "fax_number": "501-358-6714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YACOB",
        "first_name": "OMAR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-23",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-19041",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "AR",
            "license": "E-19041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.