NPIMap

Individual provider Active NPI

Jeremiah Scott Rutherford, M.D.

  • Internal Medicine Physician
  • Maumelle, AR
National Provider Identifier
1801035969
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E-10897 Issued in AR
Practice address
1701 Club Manor Dr Ste 2B
Maumelle, AR 72113-7401
Phone
(501) 851-7402
Fax
(501) 851-4753
NPI assigned
Feb 13, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E-10897 AR Primary
Internal Medicine Physician 207R00000X 26821 OK

Addresses

Primary practice location

1701 Club Manor Dr Ste 2B
Maumelle, AR 72113-7401

Mailing address

11001 Executive Center Dr Ste 200
Little Rock, AR 72211-4393
Phone (501) 851-7402

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180426000259 AR Practitioner - Internal Medicine 3870633183 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sebastian Physician Services, PLLCGroup PAC ID 5294178448, 41 clinicians

Practice addresses (Care Compare)

1001 Towson Ave
Fort Smith, AR 72901-4921
Phone (479) 441-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C-10897ARMDInternal Medicine Physician
26821OKMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Post Discharge Services, PLLC CurrentSince Jun 1, 2024 Accepting new patients
St Marys Physician Services, LLC CurrentSince Mar 14, 2018 Accepting new patients
Crawford Physician Services, PLLC CurrentSince Jun 1, 2024 Accepting new patients
St Mary's Physician Services LLC Internal Medicine CurrentSince Mar 14, 2018 Accepting new patients
Sebastian Physician Services, PLLC CurrentSince Jun 1, 2024 Accepting new patients
Baptist Health Regional Hospitals Past Accepting new patients
St Marys Physician Services, LLC Past Accepting new patients

Locations

1001 Towson Ave
Fort Smith, AR 72901
Phone (479) 441-3980

1808 W Main St
Russellville, AR 72801
Phone (479) 964-4178

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

211 Crawford Memorial Dr
Van Buren, AR 72956
Phone (479) 471-4300

Organizations & group practices 7

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1234483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788998400000",
    "number": "1801035969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DR STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114393",
            "telephone_number": "501-851-7402",
            "fax_number": "501-851-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CLUB MANOR DR STE 2B",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721137401",
            "telephone_number": "501-851-7402",
            "fax_number": "501-851-4753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTHERFORD",
        "first_name": "JEREMIAH",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-13",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-10897",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "26821",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumelle, AR

Sources for this page

Verify at the official NPI Registry.