RUSSELL DERMATOLOGY OF CONWAY, PLLC
NPI 1639134067
Dermatology in Conway, AR

NPI Status: Active since April 19, 2006

Contact Information

2425 DAVE WARD DR
SUITE 202
CONWAY, AR
ZIP 72034
Phone: (501) 328-5050
Fax: (501) 328-2131

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  • Organization
  • Dermatology
  • Accepts Insurance
  • CLIA Number: 04D0976193
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 12-18-2025

About RUSSELL DERMATOLOGY OF CONWAY, PLLC

This page provides the complete NPI Profile along with additional information for Russell Dermatology Of Conway, Pllc, a provider established in Conway, Arkansas operating as a Dermatology. The healthcare provider is registered in the NPI registry with number 1639134067 assigned on April 2006. The practitioner's primary taxonomy code is 207N00000X with license number E1574 (AR). The provider is registered as an organization and their NPI record was last updated 15 years ago. Russell Dermatology Of Conway, Pllc operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The authorized official of this NPI record is Mrs. Jackie D Russell (Bus/office Mgr)

NPI
1639134067
Provider Name
RUSSELL DERMATOLOGY OF CONWAY, PLLC
Entity Type
Organization
Location Address
2425 DAVE WARD DR SUITE 202 CONWAY, AR 72034
Location Phone
(501) 328-5050
Location Fax
(501) 328-2131
Mailing Address
2425 DAVE WARD DR SUITE 202 CONWAY, AR 72034
Mailing Phone
(501) 328-5050
Mailing Fax
(501) 328-2131
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
04-19-2006
Last Update Date
10-28-2010
Code Navigator

A dermatologist like Russell Dermatology Of Conway, Pllc is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Dermatology

Taxonomy Code
207N00000X
Type
Allopathic & Osteopathic Physicians
License No.
E1574
License State
AR
Taxonomy Description
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.

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Choice Bronze HSA (QualChoice) - POS
  • Complete Gold - PPO
  • Complete Gold + Vision + Adult Dental - PPO
  • Complete Silver (QualChoice) - POS
  • Connected Silver - PPO
  • Connected Silver (QualChoice) - POS
  • Connected Silver (QualChoiceLife) - PPO
  • Connected Silver + Vision + Adult Dental - PPO
  • Elite Bronze - PPO
  • Elite Bronze + Vision + Adult Dental - PPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Complete Silver - EPO
  • Complete Silver + Vision + Adult Dental - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Everyday Gold - EPO
  • Everyday Gold + Vision + Adult Dental - EPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Elite Gold - EPO
  • Elite Gold + Vision + Adult Dental - EPO
  • Elite Silver - EPO
  • Elite Silver + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Choice Bronze HSA - HMO
  • Choice Bronze HSA + Vision + Adult Dental - HMO
  • Complete Gold - HMO
  • Complete Gold + Vision + Adult Dental - HMO
  • Complete Silver - HMO
  • Complete Silver + Vision + Adult Dental - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Everyday Gold - HMO
  • Everyday Gold + Vision + Adult Dental - HMO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Complete Silver - EPO
  • Complete Silver + Vision + Adult Dental - EPO
  • Everyday Gold - EPO
  • Everyday Gold + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Elite Bronze - PPO
  • Elite Bronze + Vision + Adult Dental - PPO
  • Elite Gold - PPO
  • Elite Gold + Vision + Adult Dental - PPO
  • Everyday Bronze - PPO
  • Everyday Bronze + Vision + Adult Dental - PPO
  • Everyday Gold - PPO
  • Everyday Gold + Vision + Adult Dental - PPO
  • Focused Silver - PPO
  • Focused Silver + Vision + Adult Dental - PPO
  • Clear Silver - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Elite Gold - EPO
  • Elite Gold + Vision + Adult Dental - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Everyday Gold - EPO

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MRS. JACKIE D RUSSELL

Authorized Official Title
BUS/OFFICE MGR
Authorized Official Phone
(501) 328-5050

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
5C773MEDICARE ID-TYPE UNSPECIFIED (04)ARMEDICARE
140625002MEDICAID (05)AZ 

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
04D0976193
Facility Type
Physician Office
Certificate Effective Date
December 19, 2023
Certificate Expiration Date
December 18, 2025
Laboratory Director
DR. BRIAN E. RUSSELL
Certificate Type
Certificate of Compliance
Certificate Type Description
This CLIA certificate is issued to Russell Dermatology Of Conway, Pllc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1639134067
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2669238012
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 6 + 9 + 2 + 3 + 8 + 0 + 1 + 2 + 24 = 63
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 63 = 77

The NPI number 1639134067 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1265419774 RANDAL G BOWLIN MD
Individual
Family Medicine2425 DAVE WARD DR STE 401
CONWAY, AR 72034
(501) 329-3824
1063499150 JOE C CUMMINS MD
Individual
Family Medicine2425 DAVE WARD DR SUITE 401
CONWAY, AR 72034
(501) 329-3824
1861479966 LANDER A SMITH MD
Individual
Family Medicine2425 DAVE WARD DR SUITE 401
CONWAY, AR 72034
(501) 329-3824
1730166844 DAVID L NAYLOR MD
Individual
Family Medicine2425 DAVE WARD DR STE 401
CONWAY, AR 72034
(501) 329-3824
1457330011DR. SHELLEY W RUSSELL M.D.
Individual
Dermatology2425 DAVE WARD DR SUITE 202
CONWAY, AR 72034
(501) 328-5050
1033198510DR. ERIC BRIAN RUSSELL M.D.
Individual
Dermatology2425 DAVE WARD DR SUITE 202
CONWAY, AR 72034
(501) 328-5050
1477522217SELECT PHYSICAL THERAPY HOLDINGS INC
Organization
Clinic/Center (Physical Therapy)2425 DAVE WARD DR NUMBER 103
CONWAY, AR 72034
(501) 327-1730
1407811169DR. DAVID MICHAEL ARNOLD M.D.
Individual
Orthopaedic Surgery (Orthopaedic Surgery of the Spine)2425 DAVE WARD DR SUITE 201
CONWAY, AR 72034
(501) 329-7246
1558536219MS. KATHLEEN E. PHILLIPS M.S., CCC-A
Individual
Audiologist2425 DAVE WARD DR SUITE 101
CONWAY, AR 72034
(501) 932-7600
1902043227SAINT-MARK ENTERPRISES 1890 LLC
Organization
Pharmacy (Community/Retail Pharmacy)2425 DAVE WARD DR SUITE 602
CONWAY, AR 72034
(501) 329-7777
1558667683ANNETTE N. ANDERSON, MD, PA
Organization
Psychiatry & Neurology (Geriatric Psychiatry)2425 DAVE WARD DR SUITE 102
CONWAY, AR 72034
(501) 932-0480
1740481274 TRUDY DAVIS FORBUSH PHYSICAL THERAPIST
Individual
Physical Therapist2425 DAVE WARD DR
CONWAY, AR 72034
(501) 327-1730
1861455057BOWLIN-CUMMINS PA
Organization
Clinic/Center (Rural Health)2425 DAVE WARD DR STE 401
CONWAY, AR 72034
(501) 329-3824
1992180269 NATALIE CLAIRE BROWND APRN
Individual
Nurse Practitioner (Family)2425 DAVE WARD DR SUITE #401
CONWAY, AR 72034
(501) 329-3824
1962862557MRS. RACHEL CHOATE MSN, APRN, FNP-C
Individual
Nurse Practitioner (Family)2425 DAVE WARD DR SUITE 202
CONWAY, AR 72034
(501) 328-5050
1871990937THE PAIN MEDICINE CONSULTANTS GROUP
Organization
Durable Medical Equipment & Medical Supplies2425 DAVE WARD DR GORDY BUILDING STE 102
CONWAY, AR 72034
(501) 764-1150
1114461118DR. LEAH MARIE LAMB
Individual
Pharmacist2425 DAVE WARD DR SUITE 602
CONWAY, AR 72034
(501) 329-3777
1023099009 DAVID WILLIAM SMITH P.D.
Individual
Pharmacist2425 DAVE WARD DR STE. 602
CONWAY, AR 72034
(501) 329-3777
1790776912JJJ SMITH, INC
Organization
Pharmacist2425 DAVE WARD DR STE. 602
CONWAY, AR 72034
(501) 329-3777
1336498492DR. MATTHEW CLIFF BROWN AU.D.
Individual
Audiologist2425 DAVE WARD DR
CONWAY, AR 72034
(501) 932-7600

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1639134067, enumerated in the NPI registry as an "organization" on April 19, 2006

The provider is located at 2425 Dave Ward Dr Suite 202 Conway, Ar 72034 and the phone number is (501) 328-5050

This medical organization specializes in Dermatology with taxonomy code 207N00000X

The provider might be accepting Accepts: Ambetter from Arkansas Health & Wellness, Ambetter. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

The provider's CLIA number is 04D0976193 for a "physician office" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing..

This NPI record was last updated on April 19, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.