NPIMap

Organization Active NPI

Vitality Plus LLC

Doing business as Vitality Plus

  • Clinic/Center
  • Mountain Home, AR
National Provider Identifier
1023639614
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
VITALITY PLUS LLC
Doing business as
Vitality Plus
Practice address
501 Hospital Dr
Mountain Home, AR 72653-2912
Phone
(870) 580-0283
Fax
(870) 580-0297
NPI assigned
May 5, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Authorized official

Name
Daniel B Decker, MDNPI 1205039807
Title
Owner
Phone
(870) 232-5215

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
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

501 Hospital Dr
Mountain Home, AR 72653-2912

Mailing address

501 Hospital Dr
Mountain Home, AR 72653-2912
Phone (870) 580-0283

Other names 1

  • Vitality Plus Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Avast

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200618000246 AR Part B Supplier - Clinic/Group Practice 8325460678 Receives reassigned benefits from 7 practitioners
Practice locations: Mountain Home, AR

National Provider Directory

National Provider Directory

Locations

19 Medical Plz
Mountain Home, AR 72653
Phone (870) 232-0885

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1023639614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 HOSPITAL DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532912",
            "telephone_number": "870-580-0283",
            "fax_number": "870-580-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 HOSPITAL DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532912",
            "telephone_number": "870-580-0283",
            "fax_number": "870-580-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY PLUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-05",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "DECKER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-232-5215",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Avast",
            "affiliation": "N",
            "address_1": "501 Hospital Dr",
            "city": "Mountain Home",
            "state": "AR",
            "country_code": "US",
            "postal_code": "726532912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Vitality Plus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vitality Plus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; 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.