NPIMap

Organization Active NPI

Bentonville Radiology Consultants, PLLC

  • Diagnostic Radiology Physician
  • Bentonville, AR
National Provider Identifier
1003882747
Registry record updated May 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
BENTONVILLE RADIOLOGY CONSULTANTS, PLLC
Practice address
3000 Medical Center Pkwy
Bentonville, AR 72712-3217
Phone
(479) 553-1000
Fax
(918) 664-6120
NPI assigned
Feb 23, 2006
Last updated
May 24, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David G Jong, MDNPI 1083679153
Title
Managing Partner
Phone
(918) 392-1706

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

3000 Medical Center Pkwy
Bentonville, AR 72712-3217

Mailing address

PO Box 1029
Fayetteville, AR 72702-1029
Phone (918) 392-1706

Other identifiers 2

IdentifierTypeStateIssuer
5F285OtherARARK. BCBS
156414002MedicaidAR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337817600000",
    "number": "1003882747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1029",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727021029",
            "telephone_number": "918-392-1706",
            "fax_number": "918-664-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 MEDICAL CENTER PKWY",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123217",
            "telephone_number": "479-553-1000",
            "fax_number": "918-664-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENTONVILLE RADIOLOGY CONSULTANTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2012-05-24",
        "status": "A",
        "authorized_official_last_name": "JONG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "918-392-1706",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARK. BCBS",
            "identifier": "5F285",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156414002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.