DE QUEEN FAMILY MEDICAL ASSOCIATES PLLC
NPI 1104678820
Family Medicine in De Queen, AR
About De Queen Family Medical Associates Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DE QUEEN FAMILY MEDICAL ASSOCIATES PLLC (NPI 1104678820) is a healthcare organization registered as a family medicine in De Queen, Arkansas and active in the NPI registry since April 2024. The organization holds a CLIA Waiver certificate valid through March 24, 2028 and lists William H. Kelley, Authorized Official, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
De Queen Family Medical Associates Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to De Queen Family Medical Associates PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (3)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 04D2301302
De Queen Family Medical Associates PLLC · De Queen, ARFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is De Queen Family Medical Associates PLLC's NPI number?
The NPI number for De Queen Family Medical Associates PLLC is 1104678820. It was assigned to this organization in the NPPES registry on April 4, 2024.
Where is De Queen Family Medical Associates PLLC located?
De Queen Family Medical Associates PLLC is located at 500 E Collin Raye Dr, De Queen, AR 71832. The listed phone number is (870) 584-3627.
What is De Queen Family Medical Associates PLLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is De Queen Family Medical Associates PLLC enrolled in Medicare?
Yes. De Queen Family Medical Associates PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through De Queen Family Medical Associates PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to De Queen Family Medical Associates PLLC, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does De Queen Family Medical Associates PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 04D2301302) is associated with this NPI, valid through March 24, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for De Queen Family Medical Associates PLLC was last updated on May 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# De Queen Family Medical Associates Pllc · NPI 1104678820
Family Medicine organization in De Queen, Arkansas. Organization record, active in the CMS NPPES registry since April 4, 2024.
## Identity
- **NPI:** 1104678820 (Entity type: Organization)
- **Enumerated:** April 4, 2024
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** William Kelley, AUTHORIZED OFFICIAL
## Practice location
- **Address:** 500 E COLLIN RAYE DR, De Queen, AR 71832-8048
- **Phone:** (870) 584-3627
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (2), Family Practice (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 31, 2024
- **Other identifiers:** Medicaid 319492002 (AR)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104678820) · Data from the CMS NPPES public registry.