NPIMap

Organization Active NPI

Arkansas Health Group

Doing business as Baptist Health Family Clinic Otter Creek

  • Family Medicine Physician
  • Little Rock, AR
National Provider Identifier
1649518333
Registry record updated Apr 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ARKANSAS HEALTH GROUP
Doing business as
Baptist Health Family Clinic Otter Creek
Practice address
11321 Interstate 30 Ste 101
Little Rock, AR 72209-7064
Phone
(501) 455-1331
NPI assigned
Jan 30, 2013
Last updated
Apr 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2019

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

Authorized official

Name
Mr. Will L Rusher
Title
Ceo
Phone
(501) 812-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

11321 Interstate 30 Ste 101
Little Rock, AR 72209-7064

Mailing address

11001 Executive Center Dr Ste 200
Little Rock, AR 72211-4393
Phone (501) 812-7215

Other identifiers 1

IdentifierTypeStateIssuer
110127001MedicaidAR

Other names 1

  • Baptist Health Family Clinic Otter Creek Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100504000229 AR Part B Supplier - Clinic/Group Practice 7911802079 Receives reassigned benefits from 7 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Little Rock, AR

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Jeffrey S Mayfield49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

Practitioners & affiliated clinicians

Practitioners 11

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": "1359504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1649518333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DR STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114393",
            "telephone_number": "501-812-7215",
            "fax_number": "501-812-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11321 INTERSTATE 30 STE 101",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722097064",
            "telephone_number": "501-455-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS HEALTH GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-30",
        "last_updated": "2019-04-11",
        "status": "A",
        "authorized_official_last_name": "RUSHER",
        "authorized_official_first_name": "WILL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "501-812-7500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110127001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Health Family Clinic Otter Creek",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baptist Health Family Clinic Otter Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.