ARKANSAS DERMATOLOGY PLLC
Complete NPI Record 1013930320
Dermatology in Little Rock, AR
Active since July 26, 2006CLIA Certified · 9 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Arkansas Dermatology Pllc (NPI 1013930320), a dermatology organization in Little Rock, AR. All 33 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1013930320 Field 1/33
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/33
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/33
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: ARKANSAS DERMATOLOGY PLLC Field 4/33
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 4261 STOCKTON DRIVE SUITE LL100 Field 5/33
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: NORTH LITTLE ROCK Field 6/33
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: AR Field 7/33
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 72117 Field 8/33
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/33
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 5019757456 Field 10/33
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 5019781822 Field 11/33
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 9601 BAPTIST HEALTH DR STE 860 Field 12/33
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: LITTLE ROCK Field 13/33
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: AR Field 14/33
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 722056375 Field 15/33
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/33
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 5019757455 Field 17/33
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 5019753631 Field 18/33
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: THOMAS Field 21/33
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: KEMMERLY Field 22/33
- The first name of the authorized official.
- Authorized Official Middle Name: DRAKE Field 23/33
- The middle name of the authorized official.
- Authorized Official Title or Position: BILLING MANAGER Field 24/33
- The title or position of the authorized official.
- Authorized Official Telephone Number: 5015158136 Field 25/33
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207N00000X Field 26/33
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 27/33
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 155107002 Field 28/33
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 29/33
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: AR Field 30/33
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Organization Subpart: N Field 31/33
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP Field 32/33
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Secondary Practice Locations 10
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
1075 Andrews Dr
Location 1/10Conway, AR 72032-4090 · Phone (501) 513-9700 · Fax (501) 513-9706
2645 Highway 25B
Location 2/10Heber Springs, AR 72543-6305 · Phone (501) 362-3100 · Fax (501) 362-3105
106 S Inglewood Ave Ste B
Location 3/10Russellville, AR 72801-3353 · Phone (479) 223-5000
120 Twin Points Road
Location 4/10Hot Springs, AR 71913 · Phone (501) 547-8372 · Fax (501) 441-2318
15506 Highway 5 Ste A
Location 5/10Cabot, AR 72023-7695 · Phone (501) 941-3101 · Fax (501) 941-3105
9601 Baptist Health Dr Ste 1070
Location 6/10Little Rock, AR 72205-6332 · Phone (501) 907-7330 · Fax (501) 975-7457
500 S University Ave Ste 708
Location 7/10Little Rock, AR 72205-5372 · Phone (501) 221-2700
2605 E Moore Ave
Location 8/10Searcy, AR 72143 · Phone (501) 268-1500 · Fax (501) 268-1505
1708 N Buerkle St
Location 9/10Stuttgart, AR 72160-2518 · Phone (870) 659-8050 · Fax (870) 673-7118
4261 Stockton Dr Ste 200
Location 10/10North Little Rock, AR 72117-2962 · Phone (501) 791-7546 · Fax (501) 753-1992
Other Provider Identifiers 1
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
155107002 Medicaid
Identifier 1/1State: AR
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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