NPIMap

Organization Active NPI

Benton Pediatric Clinic

  • Primary Care Clinic/Center
  • Benton, AR
National Provider Identifier
1497753198
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
R2391 Issued in AR
Legal business name
BENTON PEDIATRIC CLINIC
Practice address
115 McNeil St
Benton, AR 72015-3345
Phone
(501) 315-0421
Fax
(501) 778-6312
NPI assigned
Jul 7, 2005
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
Dr. Mary Jewell Atkins, M.D.
Title
Physician
Phone
(501) 315-0421

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X R2391 AR Primary

Addresses

Primary practice location

115 McNeil St
Benton, AR 72015-3345

Mailing address

115 McNeil St
Benton, AR 72015-3345
Phone (501) 315-0421

Other identifiers 1

IdentifierTypeStateIssuer
50143OtherARBLUE CROSS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497753198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 MCNEIL ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153345",
            "telephone_number": "501-315-0421",
            "fax_number": "501-778-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 MCNEIL ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153345",
            "telephone_number": "501-315-0421",
            "fax_number": "501-778-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENTON PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ATKINS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JEWELL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "501-315-0421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AR",
            "license": "R2391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "50143",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.