Bentonville Endoscopy Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BENTONVILLE ENDOSCOPY CENTER, LLC

Practice address

3700 SE Dodson Road
Suite #4
Bentonville, AR 72712

Phone

(817) 893-2381

NPI assigned

Nov 13, 2024

Organization subpart

Yes

Parent organization

THE GI ALLIANCE ACQUISITION, LLCAs reported in NPPES

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

Authorized official

Name

Kelly Rouvaldt

Title

Director of Ascs

Phone

(817) 893-2381

Specialties & licenses 1

Addresses

Other names 1

• Bentonville Endoscopy Center Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1731456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1013731397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 RESERVE ST STE 550",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760921604",
            "telephone_number": "214-697-7314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SE DODSON ROAD",
            "address_2": "SUITE #4",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "72712",
            "telephone_number": "817-893-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENTONVILLE ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GI ALLIANCE ACQUISITION, LLC",
        "enumeration_date": "2024-11-13",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "ROUVALDT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DIRECTOR OF  ASCS",
        "authorized_official_telephone_number": "817-893-2381"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bentonville Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Benton Neurocare Inc.
• Benton Nursing, LLC
• Bentonville Ambulatory Surgery Center, LLC
• Bentonville Anesthesia PLLC
• Bentonville Assisted Living Services
• Bentonville Eye Care PLLC
• Bentonville Medical Arts PLLC
• Bentonville Pediatrics
• Bentonville Physical Therapy Specialists
• Bentonville Public Schools

• All providers in Bentonville, AR
• Ambulatory Surgical Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.