NPIMap

Organization Active NPI

Prime Medical Group PLLC

Doing business as Dermatology Group of Arkansas PA

  • Dermatology Physician
  • Camden, AR
National Provider Identifier
1790384899
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PRIME MEDICAL GROUP PLLC
Doing business as
Dermatology Group of Arkansas PA
Dermatology Group of Arkansas, PA
Practice address
353 Cash Rd SW
Camden, AR 71701-3704
Phone
(501) 227-8422
Fax
(501) 537-2399
NPI assigned
Oct 20, 2020
Last updated
Oct 20, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIME MEDICAL GROUP PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Authorized official

Name
Ray Kohler ParkerNPI 1558356360
Title
Physician
Phone
(501) 227-8422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

353 Cash Rd SW
Camden, AR 71701-3704

Mailing address

9601 Baptist Health Dr Ste 690
Little Rock, AR 72205-6328
Phone (501) 227-8422

Other identifiers 1

IdentifierTypeStateIssuer
239906002MedicaidAR

Other names 2

  • Dermatology Group of Arkansas PA Doing business as
  • Dermatology Group of Arkansas, PA Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Prime Medical Group PLLC6 organizations share this tax ID, including this one
Part of
Prime Medical Group PLLC

Other organizations with this tax ID 5

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 1

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": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1790384899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9601 BAPTIST HEALTH DR STE 690",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056328",
            "telephone_number": "501-227-8422",
            "fax_number": "501-537-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 CASH RD SW",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717013704",
            "telephone_number": "501-227-8422",
            "fax_number": "501-537-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME MEDICAL GROUP PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIME MEDICAL GROUP PLLC",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "RAY",
        "authorized_official_middle_name": "KOHLER",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "501-227-8422"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "239906002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology Group of Arkansas PA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dermatology Group of Arkansas, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camden, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.