Arkansas Renal Group PA
Organization Active NPI Nephrology Physician · Russellville, AR
NPI 1922769322 · NPPES record last updated Jan 7, 2022
Key facts
- NPI
- 1922769322
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nephrology Physician 207RN0300X
- Legal business name
- ARKANSAS RENAL GROUP PA
- Practice address
- 111 Skyline Dr
Russellville, AR 72801-3363 - Phone
- (501) 624-6000
- Fax
- (501) 321-0710
- NPI assigned
- Jan 7, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- ARKANSAS RENAL GROU PA
Authorized official
- Name
- Jerry Edgin, CPA
- Title
- Chief Executive Officer
- Phone
- (501) 624-6000
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 3
Practitioners 21
-
David Desoto, M.D.
-
Michael S Gersch, MD
-
Jennifer Lea Hocutt, APRN
-
Jacqueline Devin Price, APRN
-
Rachael Lynn Stauder, APRN
-
Naveen Trehan, MD
-
Dasaradha Uyyala, MD
-
Drew Courtney Heiple, M.D.
-
Johnnie Hinton III, M.D.
-
Melissa Lowman, APRN-CPN
-
Michael D Schonefeld, M.D.
-
Pamela Jean Schonefeld, MD, FACP
-
Brittany Calvert, PA-C
-
April Hardin, APRN
-
Lisa McAdams, APN
-
Tanya Williams, APN
-
Julie Marie Wylie, ANP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2112078 | Arkansas Renal Group, PA - Russellville | Certificate of waiver | Apr 20, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220406001085 | AR | Part B Supplier - Clinic/Group Practice | 8921274721 |
Receives reassigned benefits from 11 practitioners Practice locations: Russellville, AR |
National Provider Directory
- Tax ID family
- Arkansas Renal Group PA
- Part of
- Arkansas Renal Group PA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician |
207RN0300X | Yes |
Addresses
Primary practice location
111 Skyline Dr
Russellville, AR 72801-3363
Mailing address
115 Wrights St Ste C
Hot Springs, AR 71913-6240
Phone (501) 624-6000
Other names
- Russellville Nephrology
Other providers in Russellville, AR
- Arkansas Foot Care Clinic, Inc
- Arkansas Health Group
- Arkansas Hospice, Inc.
- Arkansas Liver and Gastroenterology, P.a.
- Arkansas Nephrology Services, LTD.
- Arkansas Urology, P.a.
- Arkansas Valley Anesthesia Associates, P. a.
- Arkansas Vein Care Clinics LLC
- Arkansas Wound & Wellness Clinic LLC
- Charles Armstrong
All providers in Russellville, AR · Nephrology Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.