RUSSELL DERMATOLOGY OF CONWAY, PLLC
NPI 1639134067
Dermatology in Conway, AR
About Russell Dermatology Of Conway, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RUSSELL DERMATOLOGY OF CONWAY, PLLC (NPI 1639134067) is a healthcare organization registered as a dermatology in Conway, Arkansas and active in the NPI registry since April 2006. The organization holds a CLIA Microscopy certificate valid through August 10, 2027 and lists Jackie D Russell, Bus/office Mgr, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Russell Dermatology Of Conway, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Russell Dermatology Of Conway, PLLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.
Clinicians, nearest first (4)
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 for Provider-Performed Microscopy Procedures (PPMP) 04D0976193
Russell Dermatology Of Conway PLLC · Conway, 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 Russell Dermatology Of Conway, PLLC's NPI number?
The NPI number for Russell Dermatology Of Conway, PLLC is 1639134067. It was assigned to this organization in the NPPES registry on April 19, 2006.
Where is Russell Dermatology Of Conway, PLLC located?
Russell Dermatology Of Conway, PLLC is located at 2425 Dave Ward Dr Suite 202, Conway, AR 72034. The listed phone number is (501) 328-5050.
What is Russell Dermatology Of Conway, PLLC's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Russell Dermatology Of Conway, PLLC enrolled in Medicare?
Yes. Russell Dermatology Of Conway, PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Russell Dermatology Of Conway, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Russell Dermatology Of Conway, PLLC. 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. The largest specialties are Dermatology (3) and Nurse Practitioner (1). Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Russell Dermatology Of Conway, PLLC hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 04D0976193) is associated with this NPI, valid through August 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Russell Dermatology Of Conway, PLLC accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 1 other insurer list Russell Dermatology Of Conway, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Russell Dermatology Of Conway, PLLC was last updated on October 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.
# Russell Dermatology Of Conway, Pllc · NPI 1639134067
Dermatology organization in Conway, Arkansas. Organization record, active in the CMS NPPES registry since April 19, 2006.
## Identity
- **NPI:** 1639134067 (Entity type: Organization)
- **Enumerated:** April 19, 2006
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** Jackie Russell, BUS/OFFICE MGR
## Practice location
- **Address:** 2425 DAVE WARD DR, SUITE 202, Conway, AR 72034-8686
- **Phone:** (501) 328-5050 · **Fax:** (501) 328-2131
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (3), Nurse Practitioner (1); 3 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 9, 2025
- **Other identifiers:** Medicaid 140625002 (AZ)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1639134067) · Data from the CMS NPPES public registry.