NPIMap

Organization Active NPI

Ozark Surgical Associates

  • Surgery Physician
  • Fayetteville, AR
National Provider Identifier
1013905587
Registry record updated Nov 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
C7126 Issued in AR
Legal business name
OZARK SURGICAL ASSOCIATES
Practice address
3017 N Bob Younkin Dr
Suite 101
Fayetteville, AR 72703-3926
Phone
(479) 521-1484
Fax
(479) 521-1550
NPI assigned
Oct 10, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2009

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

Authorized official

Name
Mrs. Clara J. Peters
Title
Practice Administrator
Phone
(479) 521-1484

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X C7126 AR Primary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X E0751 AR
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X E3076 AR
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X N8290 AR

Addresses

Primary practice location

3017 N Bob Younkin Dr
Suite 101
Fayetteville, AR 72703-3926

Mailing address

3017 N Bob Younkin Dr
Suite 101
Fayetteville, AR 72703-3926
Phone (479) 521-1484

Other identifiers 1

IdentifierTypeStateIssuer
146704002MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040728000779 AR Part B Supplier - Clinic/Group Practice 7911977871 Receives reassigned benefits from 3 practitioners
Practice locations: Fayetteville, AR

National Provider Directory

National Provider Directory

Locations

3000 NW A St
Ste 101
Bentonville, AR 72712
Phone (479) 521-1484

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257811200000",
    "number": "1013905587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3017 N BOB YOUNKIN DR",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033926",
            "telephone_number": "479-521-1484",
            "fax_number": "479-521-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 N BOB YOUNKIN DR",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033926",
            "telephone_number": "479-521-1484",
            "fax_number": "479-521-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARK SURGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2009-11-10",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "CLARA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "479-521-1484",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "AR",
            "license": "C7126",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "AR",
            "license": "E0751",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "AR",
            "license": "E3076",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": "N8290",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146704002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.