Individual provider Active NPI

Eric J Stewart, MD

  • Specialist
  • Fayetteville, AR
National Provider Identifier
1801973870
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
E4409 Issued in AR
Practice address
4375 N. Vantage Dr.
Suite 305
Fayetteville, AR 72703-4984
Phone
(479) 443-5100
Fax
(479) 443-5117
NPI assigned
Nov 1, 2006
Last updated
Feb 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X E4409 AR Primary
Dermatology Physician 207N00000X E4409 AR

Addresses

Primary practice location

4375 N. Vantage Dr.
Suite 305
Fayetteville, AR 72703-4984

Mailing address

4375 N. Vantage Dr.
Suite 305
Fayetteville, AR 72703-4984
Phone (479) 443-5100

Other identifiers 1

IdentifierTypeStateIssuer
15763100MedicaidAR

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
I20050718000906 AR Practitioner - Dermatology 0042247496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Arkansas College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ozark Dermatology ClinicGroup PAC ID 5799712147, 15 clinicians

Practice addresses (Care Compare)

4375 N Vantage Dr
Suite 305
Fayetteville, AR 72703-4984

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision169
Removal of skin lesions1993
Removal of nail tissue1-10
Skin biopsy857

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E4409ARMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ozark Dermatology Clinic Specialist CurrentSince Jul 1, 2000 Accepting new patients
Ameripath SC Inc PastSince Aug 1, 2005 Accepting new patients

Locations

152 E Appleby Rd
Fayetteville, AR 72703
Phone (479) 445-6884

4375 N Vantage Dr
Ste 305
Fayetteville, AR 72703
Phone (479) 443-5100

117 S Dixieland St
Ste C
Lowell, AR 72745
Phone (479) 347-2700

3632 Johnson Mill Blvd
Ste 105
Springdale, AR 72762
Phone (479) 966-4174

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1801973870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4375 N. VANTAGE DR.",
            "address_2": "SUITE 305",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034984",
            "telephone_number": "479-443-5100",
            "fax_number": "479-443-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4375 N. VANTAGE DR.",
            "address_2": "SUITE 305",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034984",
            "telephone_number": "479-443-5100",
            "fax_number": "479-443-5117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "ERIC",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AR",
            "license": "E4409",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AR",
            "license": "E4409",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15763100",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.