NPIMap

Organization Active NPI

Prime Medical Group PLLC

  • Dermatology Physician
  • Pine Bluff, AR
National Provider Identifier
1629677737
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PRIME MEDICAL GROUP PLLC
Practice address
1416 W 43Rd Ave
Pine Bluff, AR 71603-7010
Phone
(870) 535-7477
Fax
(870) 535-4121
NPI assigned
Oct 20, 2020
Last updated
Oct 20, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIME MEDICAL GROUP PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Authorized official

Name
Ray Kohler ParkerNPI 1558356360
Title
Physician
Phone
(501) 227-8422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

1416 W 43Rd Ave
Pine Bluff, AR 71603-7010

Mailing address

9601 Baptist Health Dr Ste 690
Little Rock, AR 72205-6328
Phone (501) 227-8422

Other identifiers 1

IdentifierTypeStateIssuer
2399040002MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Prime Medical Group PLLC6 organizations share this tax ID, including this one
Part of
Prime Medical Group PLLC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1629677737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9601 BAPTIST HEALTH DR STE 690",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056328",
            "telephone_number": "501-227-8422",
            "fax_number": "501-537-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 W 43RD AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037010",
            "telephone_number": "870-535-7477",
            "fax_number": "870-535-4121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME MEDICAL GROUP PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIME MEDICAL GROUP PLLC",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "RAY",
        "authorized_official_middle_name": "KOHLER",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "501-227-8422"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2399040002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.