NPIMap

Organization Active NPI

Pocahontas Medical Clinic PA

  • Family Medicine Physician
  • Pocahontas, AR
National Provider Identifier
1700554177
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
POCAHONTAS MEDICAL CLINIC PA
Practice address
1601 Market Dr
Pocahontas, AR 72455-1491
Phone
(870) 892-4467
Fax
(870) 892-4467
NPI assigned
Sep 1, 2021
Organization subpart
Yes
Parent organization
POCAHONTAS MEDICAL CLINIC, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Cindy A Markum
Title
Credentialing Coordinator
Phone
(870) 892-4467

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1601 Market Dr
Pocahontas, AR 72455-1491

Mailing address

2901 Medical Center Dr
Pocahontas, AR 72455-9438
Phone (870) 892-4467

Other names 1

  • Pocahontas Medical Clinic, PA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040702000397 AR Part B Supplier - Clinic/Group Practice 4688651029 Receives reassigned benefits from 19 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Corning, AR; Pocahontas, AR

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2032677Pocahontas Medical Clinic East1601 Market Dr, Pocahontas, AR 72455ComplianceOct 22, 2026

National Provider Directory

National Provider Directory
Tax ID family
Pocahontas Medical Clinic PA2 organizations share this tax ID, including this one
Part of
Pocahontas Medical Clinic PA

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1700554177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 MEDICAL CENTER DR",
            "city": "POCAHONTAS",
            "state": "AR",
            "postal_code": "724559438",
            "telephone_number": "870-892-4467",
            "fax_number": "870-892-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 MARKET DR",
            "city": "POCAHONTAS",
            "state": "AR",
            "postal_code": "724551491",
            "telephone_number": "870-892-4467",
            "fax_number": "870-892-4467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCAHONTAS MEDICAL CLINIC PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POCAHONTAS MEDICAL CLINIC, PA",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "MARKUM",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "870-892-4467"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pocahontas Medical Clinic, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocahontas, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.