Kevin L St. Clair, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

R-4149 Issued in AR

Practice address

4375 N Vantage Dr
Suite 305
Fayetteville, AR 72703-4982

Phone

(479) 443-5100

Fax

(479) 443-5117

NPI assigned

Nov 1, 2006

Last updated

Nov 18, 2021By 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 2

Addresses

Other identifiers 2

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

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.

• University of Arkansas for Medical Sciences

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1588654016

  Dermatology

  Medicare reassignment NPD
• Ozark Dermatology Clinic

  • Specialist
  • Fayetteville, AR
  • NPI 1134207483
  NPD
• University of Arkansas for Medical Sciences

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

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1669534749
  NPD
• Ameripath SC Inc

  • Clinical Medical Laboratory
  • Mount Pleasant, SC
  • NPI 1528030368
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1649357690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4375 N VANTAGE DR",
            "address_2": "SUITE 305",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034982",
            "telephone_number": "479-443-5100",
            "fax_number": "479-443-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4375 N VANTAGE DR",
            "address_2": "SUITE 305",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034982",
            "telephone_number": "479-443-5100",
            "fax_number": "479-443-5117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 W Markham St",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722057101",
            "country_code": "US",
            "telephone_number": "501-686-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ST. CLAIR",
        "first_name": "KEVIN",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AR",
            "license": "R4149",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AR",
            "license": "R-4149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119113001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "16085000000",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St Francis House Nwa, Inc (Community Clinic Fayetteville High School)
• St Francis House Nwa, Inc (Owl Creek School Based Health Center Dental)
• St Francis House Nwa, Inc (Advanced Health & Wellness I)
• St Francis House Nwa, Inc (Owl Creek School Based Health Center)
• Devin Dean St. Clair, MD
• Kyle St. Peter
• Stacey R. Young, PLLC
• Adriana U. Stacey, M.D.
• Jennifer E Stafford, O.D.
• Miriam Stafford, M.S., CCC-SLP

• Dermatology Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Dermatology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.