Individual provider Active NPI

David Gregory Nelson, MD

  • Obstetrics & Gynecology Physician
  • Russellville, AR
National Provider Identifier
1720109796
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
E-6025 Issued in AR
Practice address
105 Skyline Dr
Russellville, AR 72801-3363
Phone
(479) 968-2345
Fax
(479) 890-7125
NPI assigned
Apr 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X E-6025 AR Primary

Addresses

Primary practice location

105 Skyline Dr
Russellville, AR 72801-3363

Mailing address

105 Skyline Dr
Russellville, AR 72801-3363
Phone (479) 968-2345

Other identifiers 1

IdentifierTypeStateIssuer
184465001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20100722000380 AR Practitioner - Obstetrics/Gynecology 9537291828 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Arkansas College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Physician Services LLCGroup PAC ID 4981698032, 49 clinicians

Practice addresses (Care Compare)

101 Skyline Dr
Russellville, AR 72801-3363
Phone (479) 968-2345

105 Skyline Dr
Russellville, AR 72801-3363
Phone (479) 968-2345

1808 W Main St
Russellville, AR 72801-2724
Phone (479) 968-2841

Hospital & facility affiliations

  • St Marys Regional Medical Center Hospital, Russellville, AR, CCN 040041

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-6025ARMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary'S Physician Services LLC CurrentSince Aug 1, 2010 Accepting new patients
DHP of Arkansas PA Obstetrics & Gynecology CurrentSince Jan 1, 2026 Accepting new patients
Washington Regional Medical System CurrentSince Sep 1, 2024 Accepting new patients
St Marys Physician Services, LLC CurrentSince Aug 1, 2010 Accepting new patients
Washington Regional Medical System CurrentSince Sep 1, 2024 Accepting new patients
St Marys Physician Services, LLC Past Accepting new patients

Locations

1555 Exchange Ave
Conway, AR 72032
Phone (501) 202-2300

3215 N Northhills Blvd
Fayetteville, AR 72703
Phone (479) 463-1000

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

101 Skyline Dr
Russellville, AR 72801
Phone (479) 968-2345

105 Skyline Dr
Russellville, AR 72801
Phone (479) 968-2345

Interoperability endpoints

  • Direct secure messaging: dnelson23126@washingtonregional.direct-ci.com
  • Direct secure messaging: david.nelson.1@2433.direct.athenahealth.com

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": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1720109796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SKYLINE DR",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013363",
            "telephone_number": "479-968-2345",
            "fax_number": "479-890-7125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SKYLINE DR",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013363",
            "telephone_number": "479-968-2345",
            "fax_number": "479-890-7125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "DAVID",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AR",
            "license": "E-6025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184465001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

Verify at the official NPI Registry.