NPIMap

Organization Active NPI

Stuttgart Medical Clinic, LTD

  • Family Medicine Physician
  • Stuttgart, AR
National Provider Identifier
1861518698
Registry record updated Oct 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
STUTTGART MEDICAL CLINIC, LTD
Practice address
1609 N Medical Dr
Stuttgart, AR 72160-3274
Phone
(870) 673-7211
Fax
(870) 672-6823
NPI assigned
Mar 22, 2007
Last updated
Oct 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2014

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

Authorized official

Name
Lura Wilson
Title
Clinic Administrator
Phone
(870) 674-6783

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1609 N Medical Dr
Stuttgart, AR 72160-3274

Mailing address

1609 N Medical Dr
Stuttgart, AR 72160-3274
Phone (870) 673-7211

Other identifiers 1

IdentifierTypeStateIssuer
100907002MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090511000307 AR Part B Supplier - Clinic/Group Practice 8123176658 Receives reassigned benefits from 14 practitioners
Practice locations: Stuttgart, AR

National Provider Directory

National Provider Directory

Locations

198 N Main St
Clarendon, AR 72029

1601 N Medical Dr
Stuttgart, AR 72160

1801 N Buerkle St
Stuttgart, AR 72160
Phone (281) 237-2753

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414627200000",
    "number": "1861518698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 N MEDICAL DR",
            "city": "STUTTGART",
            "state": "AR",
            "postal_code": "721603274",
            "telephone_number": "870-673-7211",
            "fax_number": "870-672-6823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 N MEDICAL DR",
            "city": "STUTTGART",
            "state": "AR",
            "postal_code": "721603274",
            "telephone_number": "870-673-7211",
            "fax_number": "870-672-6823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STUTTGART MEDICAL CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2014-10-30",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "LURA",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "870-674-6783"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100907002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuttgart, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; 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.