Charles D Davidson, M.D.
Individual provider Active NPI Family Medicine Physician · Walnut Ridge, AR
NPI 1457425902 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1457425902
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- N8263 (AR)
- Practice address
- 1210 W Main St
Walnut Ridge, AR 72476-1005 - Phone
- (870) 886-3543
- Fax
- (870) 886-3252
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 3
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Arkansas College of Medicine, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lawrence County Family Clinic, PA
Practice addresses (Care Compare)
1210 W Main St
Walnut Ridge, AR 72476-1005
Phone (870) 886-3543
Hospital & facility affiliations
- Five Rivers Medical Center Home Health
- Lawrence Memorial Hospital
- Baptist Memorial Hospital Jonesboro, Inc.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Lawrence County Family Clinic, PA |
Rural health clinic | 5% Or Greater Direct Ownership Interest Corporate Director |
Jul 6, 1999 Jul 6, 1999 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100624000848 | AR | Practitioner - Family Practice | 5890771828 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N8263 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lawrence County Family Clinic, PA | Family Medicine | Current |
Accepting new patients |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Locations
1210 W Main St
Walnut Ridge, AR 72476
Phone (870) 886-3543
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | N8263 | AR | Yes |
Addresses
Primary practice location
1210 W Main St
Walnut Ridge, AR 72476-1005
Mailing address
PO Box 719
Walnut Ridge, AR 72476-0719
Phone (870) 886-3543
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55949 | Other | AR | BLUE CROSS BLUE SHIELD |
Other providers in Walnut Ridge, AR
- Complete Healing Chiropractic, PLLC.
- Shannon Swift Cooper
- Lauren Elizabeth Crews
- Lauren Felts Crook
- Tina Cruce
- Kevin M Diamond
- Dawn Dickson
- Steve Matthew Ditto
- Diversicare Leasing Corp.
- Karla Ann Dotson
All providers in Walnut Ridge, AR · Family Medicine 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 8, 2007. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.