Arkansas Internal Medicine Clinic PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

EI875 Issued in AR

Legal business name

ARKANSAS INTERNAL MEDICINE CLINIC PA

Practice address

500 S University Ave Ste 605
Little Rock, AR 72205-5308

Phone

(501) 537-4590

NPI assigned

Mar 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Solomon Chukwuemeka Mogbo, M.DNPI 1083615348

Title

President

Phone

(501) 537-4590

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Solomon C Mogbo, M.D

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1083615348

  AR

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257724800000",
    "number": "1821117565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE STE 605",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055308",
            "telephone_number": "501-537-4590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE STE 605",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055308",
            "telephone_number": "501-537-4590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS INTERNAL MEDICINE CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2009-11-09",
        "status": "A",
        "authorized_official_last_name": "MOGBO",
        "authorized_official_first_name": "SOLOMON",
        "authorized_official_middle_name": "CHUKWUEMEKA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-537-4590",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AR",
            "license": "EI875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145707001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149931002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arkansas Heart Hospital, LLC
• Arkansas Holistic Therapy
• Arkansas Hospice, Inc.
• Arkansas Hyperbaric Associates
• Arkansas Hyperbarics Plus Performance and Wellness
• Arkansas Longevity Center, PLLC
• Arkansas Manometry LLC
• Arkansas Maxillofacial Surgery Center
• Arkansas Maxillofacial Surgery Center
• Arkansas Maxillofacial Surgery Center PLLC

• All providers in Little Rock, AR
• Specialist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; 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.