Revel Dean Porter, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

R3338 Issued in AR

Practice address

300 Carson St
Jonesboro, AR 72401-3104

Phone

(870) 932-1198

Fax

(870) 910-7700

NPI assigned

Sep 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rporter@sbpc.medalliesdirect.net

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.

• St Bernards Hospital Inc

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1336150374
  Medicare reassignment NPD
• St Bernards Hospital Inc.

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1396053096
  Medicare reassignment NPD
• St Bernards Physician Clinics Inc

  • Surgery Physician
  • Jonesboro, AR
  • NPI 1447923438
  Medicare reassignment NPD
• St Bernards Physician Clinics Inc

  • Diagnostic Radiology Physician
  • Jonesboro, AR
  • NPI 1780546051
  NPD
• St Bernards Physician Clinics, Inc.

  • Internal Medicine Physician
  • Jonesboro, AR
  • NPI 1407577216
  NPD

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211846400000",
    "number": "1861488348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104",
            "telephone_number": "870-932-1198",
            "fax_number": "870-910-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104",
            "telephone_number": "870-932-1198",
            "fax_number": "870-910-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "REVEL",
        "middle_name": "DEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2008-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "R3338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101848001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shirley Pope
• Kirk Porter, P.A.-C.
• Lakeya Porter
• Marilyn L Porter, PHD
• Patricia Ann Porter, CNP
• Sharon C Porter, QBHP
• Elton Porterfirld
• Kallie Wren Posey
• Megan Posey
• Positive Psychotherapy Services

• Internal Medicine Physician in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Internal Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.