NPIMap

Organization Active NPI

Monticello Medical Clinic, PLC

  • Family Medicine Physician
  • Star City, AR
National Provider Identifier
1982193975
Registry record updated May 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MC-1891 Issued in AR
Legal business name
MONTICELLO MEDICAL CLINIC, PLC
Practice address
1306 N. Lincoln Avenue
Star City, AR 71667
Phone
(870) 628-1388
Fax
(870) 628-1347
NPI assigned
May 4, 2018
Organization subpart
Yes
Parent organization
MONTICELLO MEDICAL CLINIC PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 4, 2018

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

Authorized official

Name
Sylvia Simon, M.D.
Title
Medical Director
Phone
(870) 367-6867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MC-1891 AR Primary

Addresses

Primary practice location

1306 N. Lincoln Avenue
Star City, AR 71667

Mailing address

906 Roberts Dr
Monticello, AR 71655-5724
Phone (870) 367-6867

Other identifiers 1

IdentifierTypeStateIssuer
139812002MedicaidAR

Other names 1

  • MMC-Star City Satellite Clinic Other name

National Provider Directory

National Provider Directory
Part of
Monticello Med Clinic P

Interoperability endpoints

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525392000000",
    "number": "1982193975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 ROBERTS DR",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716555724",
            "telephone_number": "870-367-6867",
            "fax_number": "870-367-1461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 N. LINCOLN AVENUE",
            "city": "STAR CITY",
            "state": "AR",
            "postal_code": "71667",
            "telephone_number": "870-628-1388",
            "fax_number": "870-628-1347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTICELLO MEDICAL CLINIC, PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTICELLO MEDICAL CLINIC PLC",
        "enumeration_date": "2018-05-04",
        "last_updated": "2018-05-04",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "SYLVIA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "870-367-6867",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "MC-1891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139812002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMC-Star City Satellite Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Star City, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.