Individual provider Active NPI

Stephen B Gemmell, PHD

  • Psychologist
  • Fayetteville, AR
National Provider Identifier
1508816422
Registry record updated Apr 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
0010P Issued in AR
Practice address
12 E Appleby Rd
Ste 101
Fayetteville, AR 72703-3901
Phone
(479) 463-4444
Fax
(479) 463-4499
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 0010P AR Primary

Addresses

Primary practice location

12 E Appleby Rd
Ste 101
Fayetteville, AR 72703-3901

Mailing address

12 E Appleby Rd
Ste 101
Fayetteville, AR 72703-3901
Phone (479) 463-4444

Other identifiers 2

IdentifierTypeStateIssuer
154295719MedicaidAR
5W107OtherARBLUE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050303001023 AR Practitioner - Clinical Psychologist 1355395138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12 E Appleby Rd
Suite 101
Fayetteville, AR 72703-3928
Phone (479) 463-4444

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010PARMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System CurrentSince Aug 1, 2005 Accepting new patients
Washington Regional Medical System CurrentSince Aug 1, 2005 Accepting new patients
QHG of Springdale, Inc. Psychologist Past Accepting new patients

Locations

12 E Appleby Rd
Ste 101
Fayetteville, AR 72703
Phone (479) 463-4444

12 E Appleby Rd
Fayetteville, AR 72703
Phone (479) 463-4444

Organizations & group practices 3

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 1

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303689600000",
    "number": "1508816422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "STE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-4444",
            "fax_number": "479-463-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "STE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-4444",
            "fax_number": "479-463-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEMMELL",
        "first_name": "STEPHEN",
        "middle_name": "B",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2011-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AR",
            "license": "0010P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154295719",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE",
            "identifier": "5W107",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.