Active NPI
Benjamin Asafo-Boakye, MD
- Pediatrics Physician
- Blytheville, AR
National Provider Identifier
1013937549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- E4133
- Practice address
- 1521 N 10TH St Ste F
Blytheville, AR 72315-1424 - Phone
- (870) 780-6832
- Fax
- (870) 780-6919
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | E4133 | AR | Primary |
Addresses
Primary practice location
1521 N 10TH St Ste F
Blytheville, AR 72315-1424
Mailing address
1521 N 10TH St Ste F
Blytheville, AR 72315-1424
Phone (870) 780-6832
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 154161001 | Medicaid | AR | |
| 5M945 | Other | AR | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E4133 | AR | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Medicine Associates of Blytheville PA | Past | Accepting new patients | |
| Great River Pediatric Clinic | Pediatrics | Past | Accepting new patients |
| Ozarks Medical Center | Past | Accepting new patients |
Interoperability endpoints
- baboakye@greatriverpediatricclinic.ssdirect.aprima.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Blytheville, AR
- NPI 1467586131
-
- Family Medicine Physician
- Blytheville, AR
- NPI 1609934249
-
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320883200000",
"number": "1013937549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1521 N 10TH ST STE F",
"city": "BLYTHEVILLE",
"state": "AR",
"postal_code": "723151424",
"telephone_number": "870-780-6832",
"fax_number": "870-780-6919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1521 N 10TH ST STE F",
"city": "BLYTHEVILLE",
"state": "AR",
"postal_code": "723151424",
"telephone_number": "870-780-6832",
"fax_number": "870-780-6919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ASAFO-BOAKYE",
"first_name": "BENJAMIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2011-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AR",
"license": "E4133",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "154161001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "5M945",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blytheville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.