Omar T Atiq, M.D.
Individual provider Active NPI Specialist · Pine Bluff, AR
NPI 1770549511 · NPPES record last updated Oct 20, 2020
Key facts
- NPI
- 1770549511
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- R4174 (AR)
- Practice address
- 7200 S Hazel St
Pine Bluff, AR 71603-7836 - Phone
- (870) 535-2800
- Fax
- (870) 535-2801
- NPI assigned
- Apr 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Hematology/Oncology
- Education
- Other, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- University of Arkansas for Medical Sciences
Practice addresses (Care Compare)
4301 W Markam St
Little Rock, AR 72205-7101
Phone (501) 686-8000
Hospital & facility affiliations
- University of Arkansas Medical Sciences
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100317000615 | AR | Practitioner - Hematology/Oncology | 4284619099 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R4174 | AR | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Arkansas for Medical Sciences | Current |
Accepting new patients | |
| Jefferson Hospital Association, Inc | Current |
Accepting new patients | |
| Jefferson Hospital Association, Inc | Current | Accepting new patients | |
| Jefferson Hospital Association Inc | Current |
Accepting new patients | |
| University of Arkansas for Medical Sciences | Current |
Accepting new patients |
Locations
4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278
4301 W Markham St
Little Rock, AR 72205
Phone (501) 603-1278
778 Scogin Dr
Monticello, AR 71655
Phone (870) 367-2411
1609 W 40th Ave
Ste 205
Pine Bluff, AR 71603
Phone (870) 534-1188
1600 W 40th Ave
Pine Bluff, AR 71603
Phone (870) 541-7100
7200 S Hazel St
Pine Bluff, AR 71603
Phone (870) 534-2900
4310 S Mulberry St
Pine Bluff, AR 71603
Phone (870) 534-1188
Interoperability endpoints
- atiqo@ohit.sharear.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | R4174 | AR | Yes |
Addresses
Primary practice location
7200 S Hazel St
Pine Bluff, AR 71603-7836
Mailing address
7200 S Hazel St
Pine Bluff, AR 71603-7836
Phone (870) 535-2800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119287001 | Medicaid | AR |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | atiqo@ohit.sharear.net |
Other providers in Pine Bluff, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.