David Douglass, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

E-12032 Issued in AR

Practice address

1 Childrens Way # 512-10
Little Rock, AR 72202-3500

Phone

(501) 364-1494

Fax

(501) 364-3634

NPI assigned

Feb 28, 2006

Last updated

Mar 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric MedicineAlso: Hematology/Oncology

Education

Vanderbilt University School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arkansas Childrens Professional Services Organization LLCGroup PAC ID 4688183148, 180 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arkansas Childrens Professional Services Organization LLC

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1629889464
  Medicare reassignment Care Compare group NPD
• Arkansas Childrens Hospital

  dba ACH Physicians Billing Group

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1598773079
  Medicare reassignment NPD
• University of Arkansas for Medical Sciences

  dba Childrens University Medical Group

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1346230968
  Medicare reassignment NPD
• Arkansas Children's Hospital

  • Children's Hospital
  • Little Rock, AR
  • NPI 1477561983
  NPD
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD
• University of Arkansas for Medical Sciences

  dba Schmieding Developmental Center

  • Developmental - Behavioral Pediatrics Physician
  • Lowell, AR
  • NPI 1407021280
  NPD
• Arkansas Childrens Hospital

  • Dental Clinic/Center
  • Little Rock, AR
  • NPI 1770889552
  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1639145741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 653",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-1100",
            "fax_number": "501-364-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 512-10",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-1494",
            "fax_number": "501-364-3634"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "66 Lake Concord Rd NE",
            "address_2": "CABARRUS PEDIATRIC CLINIC",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280253057",
            "country_code": "US",
            "telephone_number": "704-786-1144",
            "fax_number": "704-788-1916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "9900477",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-12032",
            "primary": true
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "AR",
            "license": "E-12032",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP TAX ID",
            "identifier": "562034548",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "895159",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1216X",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLPATH",
            "identifier": "23702",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS MEDICARE CHOICE",
            "identifier": "31605",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891216X",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "88655",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7428011",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Douglas, OTR/L, MOT
• Kristiann Douglas, M.A.
• Mabelene Douglas
• Tamanda Douglas, MD
• Tamera Shantel Douglas
• Autumn Elizabeth Dove
• Angie Dover, TEACHER
• Christopher Dover
• Lauren Dover, MHPP
• Kathryn Dowell, RDH

• Pediatrics Physician in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Pediatrics Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.