Rex E Luttrell, M.D.
Individual provider Active NPI Surgery Physician · Jacksonville, AR
NPI 1477559680 · NPPES record last updated Oct 25, 2012
Key facts
- NPI
- 1477559680
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- C-6721 (AR)
- Practice address
- 1300 Braden St
Pod B
Jacksonville, AR 72076-3719 - Phone
- (501) 978-4343
- Fax
- (501) 975-8995
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
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
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051206000952 | AR | Practitioner - General Surgery | 4183660632 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-6721 | AR | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saline Clinics LLC | Surgery | Current |
Accepting new patients |
| Surgical Clinic, PA | Past | Accepting new patients | |
| St. Vincent Medical Group | Surgery | Past | Accepting new patients |
| Jacksonville Emergency Medicine LLC | Past | Accepting new patients | |
| Saline Physician Services, LLC | Past |
Accepting new patients | |
| Central Arkansas Spine Specialist | Past | Accepting new patients |
Locations
5 Medical Park Dr
Ste 308
Benton, AR 72015
Phone (501) 315-7808
5 Medical Park Dr
Ste 102
Benton, AR 72015
Phone (501) 315-1222
5 Medical Park Dr
Ste 305
Benton, AR 72015
Phone (501) 574-7400
910 N East St
Benton, AR 72015
Phone (501) 381-2001
1 Medical Park Dr
Bryant, AR 72015
Phone (501) 776-6000
Interoperability endpoints
- https://api.platform.athenahealth.com/16686/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | C-6721 | AR | Yes |
Addresses
Primary practice location
1300 Braden St
Pod B
Jacksonville, AR 72076-3719
Mailing address
PO Box 5209
Jacksonville, AR 72078-5209
Phone (501) 978-4343
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 123268001 | Medicaid | AR | |
| 16173000000 | Other | AR | QUALCHOICE |
| 17-20039 | Other | AR | UNITED HEALTHCARE |
| P01071366 | Other | RRMEDICARE | |
| P00004959 | Other | RAILROAD MEDICARE |
Other providers in Jacksonville, AR
- Love & Care Home Care Services LLC
- Jennifer Dena Lovell
- LTC of Jacksonville, LLC
- Ronald Frank Lukas
- Whitney Luth
- M & T Healthcare Management and Services
- Sridhar Reddy Madgula
- Magnus Opus Technology
- Miekka Michelle Maile
- Lori G Main
All providers in Jacksonville, AR · Surgery 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 Oct 25, 2012. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.