NPIMap

Individual provider Active NPI

Katie Janette Carillon, P.A.C.

  • Medical Physician Assistant
  • Maumelle, AR
National Provider Identifier
1649538679
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA468 Issued in AR
Practice address
1701 Club Manor Dr Ste 2B
Maumelle, AR 72113-7401
Phone
(501) 843-4555
Fax
(501) 743-1550
NPI assigned
Apr 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA468 AR Primary

Addresses

Primary practice location

1701 Club Manor Dr Ste 2B
Maumelle, AR 72113-7401

Mailing address

11001 Executive Center Dr Ste 200
Little Rock, AR 72211-4393
Phone (501) 851-7402

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120705000137 AR Practitioner - Physician Assistant 9133384704 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Practice addresses (Care Compare)

3333 Springhill Dr
North Little Rock, AR 72117-2922
Phone (501) 851-7402

Hospital & facility affiliations

  • Baptist Health Medical Center Heber Springs Hospital, Heber Springs, AR, CCN 041312
  • White County Medical Center Hospital, Searcy, AR, CCN 040014
  • Baptist Health Medical Center North Little Rock Hospital, North Little Rock, AR, CCN 040036
  • Baptist Health Medical Center-Little Rock Hospital, Little Rock, AR, CCN 040114
  • Baptist Health Medical Center Heber Springs Nursing home, CCN 04Z312

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA468ARMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Health Group CurrentSince Oct 7, 2024 Accepting new patients
Arkansas Health Group CurrentSince Oct 7, 2024 Accepting new patients
Arkansas Central Primary Care, PLLC CurrentSince Jan 30, 2015 Accepting new patients
Southeast Arkansas Emergency Physicians LLP CurrentSince Feb 1, 2016 Accepting new patients
Physicians Network Inc Dba Cabot Medical Clinic Past Accepting new patients

Locations

2037 W Main St
Cabot, AR 72023
Phone (501) 843-4555

9601 Interstate 630
#7
Little Rock, AR 72205
Phone (501) 202-3995

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

1701 Club Manor Dr
Ste 2B
North Little Rock, AR 72113
Phone (501) 812-7216

3333 Springhill Dr
North Little Rock, AR 72117
Phone (501) 202-3000

1600 W 40th Ave
Pine Bluff, AR 71603
Phone (870) 541-7100

Interoperability endpoints

  • Direct secure messaging: kcarillon116947@direct.baptist-healthar.org

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1649538679",
    "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": "501-851-7402",
            "fax_number": "501-851-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CLUB MANOR DR STE 2B",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721137401",
            "telephone_number": "501-843-4555",
            "fax_number": "501-743-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARILLON",
        "first_name": "KATIE",
        "middle_name": "JANETTE",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-27",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PA468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumelle, AR

Sources for this page

Verify at the official NPI Registry.