PRIME MEDICAL GROUP PLLC (NPI# 1649879750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649879750 |
| Entity Type | Organization |
| Organization Name | PRIME MEDICAL GROUP PLLC |
| Practice Address |
5 Medical Park Dr Ste 200 Benton AR 72015-3732 |
| Mailing Address |
9601 Baptist Health Dr Ste 690 Little Rock AR 72205-6328 |
| Practice Telephone | 5017763800 |
| Practice Fax Number | 5017762209 |
| Mailing Telephone | 5012278422 |
| Mailing Fax Number | 5015372399 |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2020-10-20 |
| Authorized Official Name | RAY KOHLER PARKER (PHYSICIAN) |
| Authorized Official Telephone | 5012278422 |
| Is Organization Subpart | Y |
| Parent Organization Name | PRIME MEDICAL GROUP PLLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 239920002 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677737 | Prime Medical Group Pllc | Dermatology | 1416 W 43rd Ave, Pine Bluff, AR 71603-7010 | 2020-10-20 |
| 1790384808 | Prime Medical Group Pllc | Dermatology | 625 United Dr Ste 320, Conway, AR 72032-7828 | 2020-10-20 |
| 1528667672 | Prime Medical Group Pllc | Dermatology | 315 Section Line Rd Ste A&b, Hot Springs, AR 71913-6480 | 2020-10-20 |
| 1942809058 | Prime Medical Group Pllc | Dermatology | 16115 Saint Vincent Way Ste 300, Little Rock, AR 72223-3000 | 2020-10-20 |
| 1790384899 | Prime Medical Group Pllc | Dermatology | 353 Cash Rd Sw, Camden, AR 71701-3704 | 2020-10-20 |
| 1427605153 | Prime Medical Group Pllc | Dermatology | 9601 Baptist Health Dr Ste 690, Little Rock, AR 72205-6328 | 2019-08-19 |
| Street Address |
5 MEDICAL PARK DR STE 200 |
| City | BENTON |
| State | AR |
| Zip Code | 72015-3732 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790343135 | Justin King | Case Manager/Care Coordinator | 1502 Mary Kay Blv6, Benton, AR 72015 | 2019-05-31 |
| 1790253326 | Seth Alexander Weisheit | Nurse Practitioner | 824 Military Road, Benton, AR 72015 | 2018-11-13 |
| 1396269627 | Abby G Sims | Speech-Language Pathologist | 3391 Peachtree Lane, Benton, AR 72015 | 2017-07-28 |
| 1225551278 | Jessica R Poe | Case Manager/Care Coordinator | 1502 Marykay Blvd, Benton, AR 72015 | 2017-07-21 |
| 1003357997 | Jamaal Langston | Case Manager/Care Coordinator | 1502 Mark Kay Blvd, Benton, AR 72015 | 2017-03-13 |
| 1881138550 | Shannon Gachot-ridgley | Counselor | 205 South Street Suite 3, Benton, AR 72015 | 2016-12-14 |
| 1295104578 | Excel Health of Haskell, Pllc | Clinical Nurse Specialist | 6029 Us Hwy 67, Haskell, AR 72015 | 2015-09-17 |
| 1528464054 | Kacey Jo Kiker | Nurse Practitioner | 620 W South St, Benton, AR 72015 | 2014-11-11 |
| 1700218252 | Jamie Brunt | Licensed Practical Nurse | 1718 Old Hot Springs Rd, Benton, AR 72015 | 2013-08-07 |
| 1760738942 | Kari J Richards | Physical Therapist | 5701 Springhill Rd, Bryant, AR 72015 | 2012-07-25 |
| Find all providers in zip 72015 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677737 | Prime Medical Group Pllc | Dermatology | 1416 W 43rd Ave, Pine Bluff, AR 71603-7010 | 2020-10-20 |
| 1790384808 | Prime Medical Group Pllc | Dermatology | 625 United Dr Ste 320, Conway, AR 72032-7828 | 2020-10-20 |
| 1528667672 | Prime Medical Group Pllc | Dermatology | 315 Section Line Rd Ste A&b, Hot Springs, AR 71913-6480 | 2020-10-20 |
| 1487064473 | Laura Raquel Battle | Dermatology | 500 South 52nd Street, Rogers, AR 72758-7275 | 2014-04-30 |
| 1174942528 | Jacey Tanner Guthrie | Dermatology | 4200 N Rodney Parham Rd Ste 202, Little Rock, AR 72212 | 2014-04-14 |
| 1801215751 | Allison Noel Hood | Dermatology | 9601 Baptist Health Drive Suite 860, Little Rock, AR 72205 | 2014-04-08 |
| 1710229141 | Mallory Hurst | Dermatology | 800 S Church St Ste 202, Jonesboro, AR 72401 | 2013-03-24 |
| 1720333990 | Vivian Shi | Dermatology | 4018 W Capitol Ave, Little Rock, AR 72205 | 2012-07-13 |
| 1295098440 | Garrett James Nelson | Dermatology | 9601 Baptist Health Dr Ste 690, Little Rock, AR 72205-6328 | 2012-06-22 |
| 1922398577 | Megan Suzanne Evans | Dermatology | 1 Childrens Way # 576, Little Rock, AR 72202-3500 | 2011-04-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.