NPIMap

Organization Active NPI

McClintock Family Medicine

  • Family Medicine Physician
  • Harrison, AR
National Provider Identifier
1952540387
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MCCLINTOCK FAMILY MEDICINE
Practice address
306 N Chestnut St
Harrison, AR 72601-4453
Phone
(870) 741-8559
Fax
(870) 741-8423
NPI assigned
Feb 9, 2009
Last updated
Oct 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

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

Authorized official

Name
Jacob Nelson McClintock, MDNPI 1033301320
Title
Owner
Phone
(870) 741-8559

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

306 N Chestnut St
Harrison, AR 72601-4453

Mailing address

PO Box 1497
Harrison, AR 72602-1497
Phone (870) 741-8559

Other identifiers 1

IdentifierTypeStateIssuer
178239002MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090513000371 AR Part B Supplier - Clinic/Group Practice 2062561541 Receives reassigned benefits from 11 practitioners
Practice locations: Harrison, AR

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CAJIAA

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1234137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1952540387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1497",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726021497",
            "telephone_number": "870-741-8559",
            "fax_number": "870-741-8423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 N CHESTNUT ST",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726014453",
            "telephone_number": "870-741-8559",
            "fax_number": "870-741-8423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCLINTOCK FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-09",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A",
        "authorized_official_last_name": "MCCLINTOCK",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "NELSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-741-8559",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178239002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrison, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; 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.