PROVIDENCE FAMILY MEDICINE CLINIC INC
NPI 1932690617
Family Medicine in Conway, AR
About Providence Family Medicine Clinic Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PROVIDENCE FAMILY MEDICINE CLINIC INC (NPI 1932690617) is a healthcare organization registered as a family medicine in Conway, Arkansas and active in the NPI registry since May 2018. The organization lists Mohammad Idris, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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)
Providence Family Medicine Clinic Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Providence Family Medicine Clinic Inc, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently 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 Providence Family Medicine Clinic Inc's NPI number?
The NPI number for Providence Family Medicine Clinic Inc is 1932690617. It was assigned to this organization in the NPPES registry on May 29, 2018.
Where is Providence Family Medicine Clinic Inc located?
Providence Family Medicine Clinic Inc is located at 3900 Dave Ward Dr, Conway, AR 72034. The listed phone number is (501) 499-1086.
What is Providence Family Medicine Clinic Inc's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Providence Family Medicine Clinic Inc enrolled in Medicare?
Yes. Providence Family Medicine Clinic Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Providence Family Medicine Clinic Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Providence Family Medicine Clinic Inc. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Providence Family Medicine Clinic Inc was last updated on May 29, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.
# Providence Family Medicine Clinic Inc · NPI 1932690617
Family Medicine organization in Conway, Arkansas. Organization record, active in the CMS NPPES registry since May 29, 2018.
## Identity
- **NPI:** 1932690617 (Entity type: Organization)
- **Enumerated:** May 29, 2018
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Mohammad Idris, PRESIDENT
## Practice location
- **Address:** 3900 DAVE WARD DR, Conway, AR 72034-5583
- **Phone:** (501) 499-1086
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 29, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1932690617) · Data from the CMS NPPES public registry.