NPIMap

Organization Active NPI

Pulaski Surgery Clinic PA

  • Surgery Physician
  • North Little Rock, AR
National Provider Identifier
1790756328
Registry record updated Aug 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0000000878 Issued in AR
Legal business name
PULASKI SURGERY CLINIC PA
Practice address
3401 Springhill Dr
Suite 400
North Little Rock, AR 72117-2924
Phone
(501) 945-4422
Fax
(501) 945-4424
NPI assigned
Jan 31, 2006
Last updated
Aug 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2013

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

Authorized official

Name
John Michael Stair, MDNPI 1134191356
Title
President
Phone
(501) 945-4422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 0000000878 AR Primary

Addresses

Primary practice location

3401 Springhill Dr
Suite 400
North Little Rock, AR 72117-2924

Mailing address

3401 Springhill Dr
Suite 400
North Little Rock, AR 72117-2924
Phone (501) 945-4422

Other identifiers 1

IdentifierTypeStateIssuer
111089102MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000209 AR Part B Supplier - Clinic/Group Practice 1951206093 Receives reassigned benefits from 9 practitioners
Practice locations: North Little Rock, AR

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/862/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 10

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": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376352000000",
    "number": "1790756328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 SPRINGHILL DR",
            "address_2": "SUITE 400",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721172924",
            "telephone_number": "501-945-4422",
            "fax_number": "501-945-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 SPRINGHILL DR",
            "address_2": "SUITE 400",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721172924",
            "telephone_number": "501-945-4422",
            "fax_number": "501-945-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULASKI SURGERY CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2013-08-13",
        "status": "A",
        "authorized_official_last_name": "STAIR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-945-4422",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "0000000878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111089102",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.