Forrest City Family Practice Clinic, PA

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

R3762 Issued in AR

Legal business name

FORREST CITY FAMILY PRACTICE CLINIC, PA

Practice address

902 Holiday Dr
Suite 101
Forrest City, AR 72335-9183

Phone

(870) 630-1256

NPI assigned

Mar 21, 2007

Last updated

Dec 1, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Neida Byrd

Title

Billing Manager

Phone

(901) 737-3071

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15437/brand/1/csg/1/fhir/r4

Practitioners 2

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.

• George Conner III, MD

  • Family Medicine Physician
  • Forrest City, AR
  • NPI 1063460335
  Medicare reassignment NPD
• Ashley Duncan, APRN

  • Family Nurse Practitioner
  • Wynne, AR
  • NPI 1649888413
  Medicare reassignment NPD

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322697600000",
    "number": "1649396979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 HOLIDAY DR",
            "address_2": "SUITE 101",
            "city": "FORREST CITY",
            "state": "AR",
            "postal_code": "723359183",
            "telephone_number": "870-630-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 HOLIDAY DR",
            "address_2": "SUITE 101",
            "city": "FORREST CITY",
            "state": "AR",
            "postal_code": "723359183",
            "telephone_number": "870-630-1256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORREST CITY FAMILY PRACTICE CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2011-12-01",
        "status": "A",
        "authorized_official_last_name": "BYRD",
        "authorized_official_first_name": "NEIDA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "901-737-3071"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "AR",
            "license": "R3762",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AR",
            "license": "R3762",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "AR",
            "license": "R3762",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDV NUMBER",
            "identifier": "51280",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113530001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID",
            "identifier": "R3762",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Forrest City Arkansas Hospital Company, LLC (Forrest City Emergency Medicine Associates)
• Forrest City Clinic Company LLC
• Forrest City Emergency Physicians PLLC
• Forrest City Family Pharmacy LLC (Forrest City Family Pharmacy LTC)
• Forrest City Family Pharmacy LLC
• Forrest City Home Medical Equipment, LLC
• Forrest City Home Medical Equipment, LLC
• Forrest City Physician Services, PLLC
• Forrest City School District
• Michael Scott Fortner, CRNA

• Adult Medicine Physician in Forrest City, AR
• Providers in Forrest City, AR by specialty
• Adult Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; 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.