| Little Rock Diagnostic Clinic Pa | |
|
10001 Lile Dr Little Rock AR 72205-6217 | |
| (501) 227-8000 | |
| (501) 221-5895 |
| Full Name | Little Rock Diagnostic Clinic Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 10001 Lile Dr, Little Rock, Arkansas |
| Authorized Official Name and Position | Laura Jackson (QUALITY MANAGER) |
| Authorized Official Contact | 5012278000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Little Rock Diagnostic Clinic Pa 10001 Lile Dr Little Rock AR 72205-6217 Ph: (501) 227-8000 | Little Rock Diagnostic Clinic Pa 10001 Lile Dr Little Rock AR 72205-6217 Ph: (501) 227-8000 |
| NPI Number | 1497784854 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 11/08/2017 |
| Medicare PECOS PAC ID | 8820985138 |
|---|---|
| Medicare Enrollment ID | O20040302000483 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497784854 | NPI | - | NPPES |
| 104282002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jennifer M Co |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871642306 PECOS PAC ID: 6002716222 Enrollment ID: I20040112000558 |
| Provider Name | Paula J Sargent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164416368 PECOS PAC ID: 3072406842 Enrollment ID: I20040205000321 |
| Provider Name | Charles B Rickett |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801994520 PECOS PAC ID: 7911892344 Enrollment ID: I20040216000955 |
| Provider Name | Bradley S Boop |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1033145792 PECOS PAC ID: 7810984259 Enrollment ID: I20040428000668 |
| Provider Name | John Brett Ironside |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1891727855 PECOS PAC ID: 2961499223 Enrollment ID: I20040428000906 |
| Provider Name | Beverly A Beadle |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437181815 PECOS PAC ID: 9133116460 Enrollment ID: I20040428001338 |
| Provider Name | Robert F Silzer |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881626257 PECOS PAC ID: 7618964859 Enrollment ID: I20040428001461 |
| Provider Name | Ben L Beck |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1326036609 PECOS PAC ID: 1850389024 Enrollment ID: I20040505000845 |
| Provider Name | Jimmie Lou Wallace |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1326129958 PECOS PAC ID: 5698753861 Enrollment ID: I20040713000903 |
| Provider Name | Terence L Angtuaco |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1497790877 PECOS PAC ID: 8729046305 Enrollment ID: I20041229000463 |
| Provider Name | Zulekha Hamid |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1134214893 PECOS PAC ID: 9032167234 Enrollment ID: I20050104001029 |
| Provider Name | Mark Dyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114085768 PECOS PAC ID: 4284661646 Enrollment ID: I20050718001030 |
| Provider Name | Ganesh Nair |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1710915954 PECOS PAC ID: 3274561907 Enrollment ID: I20050802001398 |
| Provider Name | Lisa Longinotti |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1619965936 PECOS PAC ID: 1557392016 Enrollment ID: I20050824000549 |
| Provider Name | Michael L Lemley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598760365 PECOS PAC ID: 8820012826 Enrollment ID: I20060117001086 |
| Provider Name | Amandah J House |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1619956562 PECOS PAC ID: 8224040423 Enrollment ID: I20060706000110 |
| Provider Name | Abdel Rahman D Saleh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1467485151 PECOS PAC ID: 8123025475 Enrollment ID: I20061028000053 |
| Provider Name | Kelly N Welch |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1437216611 PECOS PAC ID: 7810090065 Enrollment ID: I20070309000017 |
| Provider Name | Don R. Fletcher |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1356378954 PECOS PAC ID: 5597860338 Enrollment ID: I20070423000596 |
| Provider Name | Jennifer Mccallum |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1760695944 PECOS PAC ID: 0648370007 Enrollment ID: I20070713000543 |
| Provider Name | Megan L. Redam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861512105 PECOS PAC ID: 8224138516 Enrollment ID: I20070716000597 |
| Provider Name | Heath Showalter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649494808 PECOS PAC ID: 4587751433 Enrollment ID: I20071024000707 |
| Provider Name | Alina M Voinea |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1164482360 PECOS PAC ID: 8527156066 Enrollment ID: I20071115000633 |
| Provider Name | Jessica Ann Joheim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336363597 PECOS PAC ID: 8224113063 Enrollment ID: I20080304000717 |
| Provider Name | David P Mcelreath |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1811198070 PECOS PAC ID: 5799713186 Enrollment ID: I20080415000806 |
| Provider Name | Dhaval H Patel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1730398660 PECOS PAC ID: 4880765874 Enrollment ID: I20080619000760 |
| Provider Name | Brian T Hughes |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1518181775 PECOS PAC ID: 1658446463 Enrollment ID: I20080813000480 |
| Provider Name | Samer Homsi |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1366604902 PECOS PAC ID: 1658446828 Enrollment ID: I20080822000253 |
| Provider Name | Roy S Jones |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1083640072 PECOS PAC ID: 0648356485 Enrollment ID: I20081030000528 |
| Provider Name | Robert Henry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457456808 PECOS PAC ID: 0143257246 Enrollment ID: I20090618000478 |
| Provider Name | Rachel Wayne |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1780792689 PECOS PAC ID: 7416008073 Enrollment ID: I20090623000075 |
| Provider Name | Thomas M Kovaleski |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1629037338 PECOS PAC ID: 2860545902 Enrollment ID: I20090806000480 |
| Provider Name | Laura M Otter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639256803 PECOS PAC ID: 5294880530 Enrollment ID: I20090909000749 |
| Provider Name | Raymond W Edwards |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851371314 PECOS PAC ID: 2466594668 Enrollment ID: I20100127000202 |
| Provider Name | Cummins Lue |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1497790562 PECOS PAC ID: 3274619010 Enrollment ID: I20100318000927 |
| Provider Name | Elizabeth Berry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043248974 PECOS PAC ID: 0547346389 Enrollment ID: I20100323000995 |
| Provider Name | Timothy Boehm |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1629013073 PECOS PAC ID: 4486730223 Enrollment ID: I20100324000491 |
| Provider Name | Lisa Lowery |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1376571281 PECOS PAC ID: 1557447398 Enrollment ID: I20100327000314 |
| Provider Name | James H Abraham |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1417985714 PECOS PAC ID: 0941386783 Enrollment ID: I20100329000680 |
| Provider Name | Sherman Jones |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1841228756 PECOS PAC ID: 7911083753 Enrollment ID: I20100415000661 |
| Provider Name | Paul E Williams |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1487682613 PECOS PAC ID: 4880770627 Enrollment ID: I20100503000360 |
| Provider Name | Laura Trigg |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1689619967 PECOS PAC ID: 9436235272 Enrollment ID: I20100504000240 |
| Provider Name | Allen Redding |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1538197256 PECOS PAC ID: 8628154465 Enrollment ID: I20100521000467 |
| Provider Name | Thomas Cain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306816087 PECOS PAC ID: 3678608320 Enrollment ID: I20100817001437 |
| Provider Name | Ronald E Daniel |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1396049730 PECOS PAC ID: 0749469567 Enrollment ID: I20110126000531 |
| Provider Name | Lindsay Daniel |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1720382161 PECOS PAC ID: 8325227150 Enrollment ID: I20110126000605 |
| Provider Name | Tina D Goff |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1770877508 PECOS PAC ID: 4284812850 Enrollment ID: I20110629000849 |
| Provider Name | Christopher J Wright |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1902983026 PECOS PAC ID: 7911000682 Enrollment ID: I20120509000279 |
| Provider Name | Shunzhong S Bao |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1619133519 PECOS PAC ID: 1951427491 Enrollment ID: I20120605000144 |
| Provider Name | Bradley A Pitts |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1679831614 PECOS PAC ID: 7113181231 Enrollment ID: I20120620000797 |
| Provider Name | Nutan Bhaskar |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1922269604 PECOS PAC ID: 4587807292 Enrollment ID: I20130828000562 |
| Provider Name | Nicholas B Begley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1578974465 PECOS PAC ID: 2264657121 Enrollment ID: I20140709000376 |
| Provider Name | Naval H Patel |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1760826887 PECOS PAC ID: 6204129257 Enrollment ID: I20160728000331 |
| Provider Name | David R Sosnoff |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1023205002 PECOS PAC ID: 5294976627 Enrollment ID: I20160825002522 |
| Provider Name | Ali S Khan |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1235332321 PECOS PAC ID: 8325236151 Enrollment ID: I20161215001946 |
| Provider Name | Shelby A Turner |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1558895433 PECOS PAC ID: 0143598136 Enrollment ID: I20170615001567 |
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