NPIMap

Organization Active NPI

Divine Mercy Health Center

  • Family Medicine Physician
  • Little Rock, AR
National Provider Identifier
1609661305
Registry record updated Apr 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DIVINE MERCY HEALTH CENTER
Practice address
6221 Colonel Glenn Rd Ste B
Little Rock, AR 72204-7731
Phone
(501) 441-5558
NPI assigned
Apr 12, 2025
Last updated
Apr 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2025

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

Authorized official

Name
Lee Wilbur, MDNPI 1003925975
Title
Managing Member
Phone
(317) 409-3019

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

6221 Colonel Glenn Rd Ste B
Little Rock, AR 72204-7731

Mailing address

6221 Colonel Glenn Rd Ste B
Little Rock, AR 72204-7731
Phone (501) 441-5558

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250623000134 AR Part B Supplier - Clinic/Group Practice 2961914437 Receives reassigned benefits from 9 practitioners
Practice locations: Little Rock, AR

National Provider Directory

National Provider Directory

Locations

6221 Colonel Glenn Rd
Ste B
Little Rock, AR 72204
Phone (501) 223-2776

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1744416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744416000000",
    "number": "1609661305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 COLONEL GLENN RD STE B",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722047731",
            "telephone_number": "501-441-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6221 COLONEL GLENN RD STE B",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722047731",
            "telephone_number": "501-441-5558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE MERCY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-12",
        "last_updated": "2025-04-12",
        "certification_date": "2025-04-12",
        "status": "A",
        "authorized_official_last_name": "WILBUR",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "317-409-3019",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.