NPIMap

Organization Active NPI

Autumn Road Family Practice, P.a,

  • Clinic/Center
  • Little Rock, AR
National Provider Identifier
1629027818
Registry record updated May 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
MC0079 Issued in AR
Legal business name
AUTUMN ROAD FAMILY PRACTICE, P.A,
Practice address
904 Autumn Rd
Suite 200
Little Rock, AR 72211-3737
Phone
(501) 227-6363
Fax
(501) 227-8629
NPI assigned
May 8, 2006
Last updated
May 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2022

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

Authorized official

Name
Dawn Drennan
Title
Administrator
Phone
(501) 626-7515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X MC0079 AR Primary

Addresses

Primary practice location

904 Autumn Rd
Suite 200
Little Rock, AR 72211-3737

Mailing address

904 Autumn Rd
Suite 200
Little Rock, AR 72211-3737
Phone (501) 227-6363

Other identifiers 1

IdentifierTypeStateIssuer
111026102MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100415000328 AR Part B Supplier - Clinic/Group Practice 1153458625 Receives reassigned benefits from 7 practitioners
Practice locations: Little Rock, AR

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D0467303Autumn Road Family Practice, PA904 Autumn Road, Suite 200, Little Rock, AR 72211ComplianceFeb 13, 2027

National Provider Directory

National Provider Directory

Locations

904 Autumn Rd
Ste 200
Little Rock, AR 72211
Phone (501) 227-6363

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22025/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 12

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": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653955200000",
    "number": "1629027818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 AUTUMN RD",
            "address_2": "SUITE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113737",
            "telephone_number": "501-227-6363",
            "fax_number": "501-227-8629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 AUTUMN RD",
            "address_2": "SUITE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113737",
            "telephone_number": "501-227-6363",
            "fax_number": "501-227-8629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN ROAD FAMILY PRACTICE, P.A,",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A",
        "authorized_official_last_name": "DRENNAN",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "501-626-7515"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": "MC0079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111026102",
            "state": "AR"
        }
    ],
    "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 May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.