NPIMap

Organization Active NPI

Lifelinc Anesthesia V, P.a.

  • Anesthesiology Physician
  • West Memphis, AR
National Provider Identifier
1063907244
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
LIFELINC ANESTHESIA V, P.A.
Practice address
2100 N 7TH St
West Memphis, AR 72301-2017
Phone
(901) 844-1590
NPI assigned
Jun 29, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Authorized official

Name
Gregory L Thompson, MDNPI 1043296957
Title
President
Phone
(901) 207-2017

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

2100 N 7TH St
West Memphis, AR 72301-2017

Mailing address

3340 Players Club Pkwy Ste 350
Memphis, TN 38125-8949
Phone (901) 844-1590

Other practice location 1

303 W Polk Ave Ste A
West Memphis, AR 72301-4235
Phone (870) 732-2100

Other practice location 2

4800 E Johnson Ave
Jonesboro, AR 72405-8413
Phone (870) 936-1000

Other practice location 3

2596 Interstate 55
Marion, AR 72364-2327
Phone (870) 559-2006

Other identifiers 1

IdentifierTypeStateIssuer
232289002MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180918001267 AR Part B Supplier - Clinic/Group Practice 8921359712 Receives reassigned benefits from 81 practitioners
Practice locations: Jonesboro, AR; West Memphis, AR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 81

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

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1530230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1063907244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 PLAYERS CLUB PKWY STE 350",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381258949",
            "telephone_number": "901-844-1590",
            "fax_number": "844-752-2163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N 7TH ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723012017",
            "telephone_number": "901-844-1590"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 W Polk Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "West Memphis",
            "state": "AR",
            "postal_code": "723014235",
            "country_code": "US",
            "telephone_number": "870-732-2100",
            "fax_number": "870-732-3027",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4800 E Johnson Ave",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724058413",
            "country_code": "US",
            "telephone_number": "870-936-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2596 Interstate 55",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "AR",
            "postal_code": "723642327",
            "country_code": "US",
            "telephone_number": "870-559-2006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFELINC ANESTHESIA V, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-29",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-207-2017",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232289002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Memphis, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; 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.