Great River Pediatric Clinic

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

E-4133 Issued in AR

Legal business name

GREAT RIVER PEDIATRIC CLINIC

Practice address

1521 N 10TH St
Ste F
Blytheville, AR 72315-1405

Phone

(870) 780-6832

Fax

(870) 780-6919

NPI assigned

Mar 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin Asafo-Boakye, M.D., MPH, FAAPNPI 1013937549

Title

Pediatrician

Phone

(870) 780-6832

Specialties & licenses 1

Addresses

Other identifiers 1

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

CLIA laboratory certificates

Practitioners 2

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

• Benjamin Asafo-Boakye, MD

  • Pediatrics Physician
  • Blytheville, AR
  • NPI 1013937549
  NPD (past) Authorized official
• Valerie Denene Woodruff, APN

  • Family Nurse Practitioner
  • Blytheville, AR
  • NPI 1558594424
  NPD (past)

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467586131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 N 10TH ST",
            "address_2": "STE F",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151405",
            "telephone_number": "870-780-6832",
            "fax_number": "870-780-6919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 N 10TH ST",
            "address_2": "STE F",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151405",
            "telephone_number": "870-780-6832",
            "fax_number": "870-780-6919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVER PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ASAFO-BOAKYE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "870-780-6832",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., MPH, FAAP"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-4133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5F511",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Great River Medical Center
• Great River Medical Center LLC
• Great River Medical Center LLC
• Great River Medical Center LLC
• Great River Medical Center LLC
• Jessica Ann Griffin, PTA
• Ashley Danielle Gross
• Guardian Mobile Transport LLC
• Katherine A Gurley, APRN
• R Dean Gurley, O.D.

• Pediatrics Physician in Blytheville, AR
• Providers in Blytheville, AR by specialty
• Pediatrics Physician in Arkansas

• 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.