Individual provider Active NPI

John R Tisdale, M.D.

  • Internal Medicine Physician
  • Little Rock, AR
National Provider Identifier
1649414525
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E-18802 Issued in AR
Practice address
1811 Rahling Rd Ste 120
Little Rock, AR 72223-4678
Phone
(501) 214-2360
Fax
(501) 214-2356
NPI assigned
Apr 23, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E-18802 AR
Pediatrics Physician 208000000X 35.121001 OH
Internal Medicine Physician 207R00000X E-18802 AR Primary
Internal Medicine Physician 207R00000X 35.121001 OH

Addresses

Primary practice location

1811 Rahling Rd Ste 120
Little Rock, AR 72223-4678

Mailing address

4301 W Markham St # 783
Little Rock, AR 72205-7101
Phone (501) 686-8000

Other practice location 1

Highway 191 and Hospital Road
Chinle, AZ 86503
Phone (928) 674-7166

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140123001865 TX Practitioner - Internal Medicine 5496983207 Reassigns benefits to 1 organization
I20260114000930 AR Practitioner - Internal Medicine 5496983207 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Arkansas for Medical SciencesGroup PAC ID 4082528955, 1,159 clinicians

Practice addresses (Care Compare)

1811 Rahling Rd
Suite 120
Little Rock, AR 72223-4678
Phone (501) 686-8000

Hospital & facility affiliations

  • University of Arkansas Medical Sciences Hospital, Little Rock, AR, CCN 040016

Merit-based Incentive Payment System (MIPS)

Final score
80.86 of 100Reported as group
Quality
61.32
Improvement activities
40
Cost
90.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-18802ARMDPediatrics Physician
35.121001OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility CurrentSince Sep 8, 2013 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Dec 15, 2025 Accepting new patients
University of Arkansas for Medical Sciences Internal Medicine CurrentSince Dec 15, 2025 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility Current Accepting new patients
DHHS PHS Naihs Chinle Comprehensive CurrentSince Sep 8, 2013 Accepting new patients
Chinle Nursing Home Past Accepting new patients

Locations

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

1 Childrens Way
Little Rock, AR 72202
Phone (501) 364-1874

4301 W Markham St
Little Rock, AR 72205
Phone (501) 603-1278

1811 Rahling Rd
Ste 120
Little Rock, AR 72223
Phone (501) 214-2360

Organizations & group practices 6

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1649414525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 783",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-686-8000",
            "fax_number": "500-526-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 RAHLING RD STE 120",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722234678",
            "telephone_number": "501-214-2360",
            "fax_number": "501-214-2356"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Highway 191 and Hospital Road",
            "address_purpose": "LOCATION",
            "city": "Chinle",
            "state": "AZ",
            "postal_code": "86503",
            "country_code": "US",
            "telephone_number": "928-674-7166",
            "fax_number": "928-674-7705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "JOHN",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-23",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-18802",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.121001",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-18802",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.121001",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.