Individual provider Active NPI

Rukmin R Hettiarachchy, MD

  • Anesthesiology Physician
  • Hot Springs, AR
National Provider Identifier
1023085842
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
E-12058 Issued in AR
Practice address
300 Werner St
Hot Springs, AR 71913-6406
Phone
(501) 664-4532
Fax
(501) 663-4335
NPI assigned
Mar 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 35938 AZ
Anesthesiology Physician 207L00000X E-12058 AR Primary

Addresses

Primary practice location

300 Werner St
Hot Springs, AR 71913-6406

Mailing address

500 S University Ave Ste 500
Little Rock, AR 72205-5307
Phone (501) 664-4532

Other identifiers 2

IdentifierTypeStateIssuer
231428MedicaidAZ
116390OtherMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190425001211 AR Practitioner - Anesthesiology 7618939273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Creighton University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Youngs Professional Services LLCGroup PAC ID 2163524992, 297 clinicians

Practice addresses (Care Compare)

300 Werner St
Hot Springs, AR 71913-6406
Phone (501) 622-1930

Hospital & facility affiliations

  • CHI St. Vincent Hospital Hot Springs Hospital, Hot Springs, AR, CCN 040026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-12058ARMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Youngs Professional Services LLC CurrentSince Dec 29, 2021 Accepting new patients

Locations

700 W Grove St
El Dorado, AR 71730
Phone (870) 863-2200

300 Werner St
Hot Springs National Park, AR 71913
Phone (501) 622-1000

Organizations & group practices 1

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1023085842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE STE 500",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055307",
            "telephone_number": "501-664-4532",
            "fax_number": "501-663-4335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WERNER ST",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719136406",
            "telephone_number": "501-664-4532",
            "fax_number": "501-663-4335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETTIARACHCHY",
        "first_name": "RUKMIN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "35938",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "E-12058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231428",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "116390",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hot Springs, AR

Sources for this page

Verify at the official NPI Registry.