NPIMap

Organization Active NPI

Delta Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Fayetteville, AR
National Provider Identifier
1073149373
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
DELTA MEDICAL GROUP INC
Practice address
375 E Millsap Rd Ste 1
Fayetteville, AR 72703-6289
Phone
(479) 935-4949
NPI assigned
Mar 18, 2020
Last updated
Mar 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

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

Authorized official

Name
Kurt Folden
Title
Ceo
Phone
(870) 333-1230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

375 E Millsap Rd Ste 1
Fayetteville, AR 72703-6289

Mailing address

PO Box 19238
Jonesboro, AR 72403-6603

Other identifiers 1

IdentifierTypeStateIssuer
163732716MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200325003842 AR DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Certified Orth/Pros/PedorthistDME Supplier - Oxygen & Equipment 7911101290 Practice locations: Fayetteville, AR

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Delta Medical Group Inc375 E Millsap Rd, Fayetteville, AR 72703-6289(479) 935-4949 Commodes, Urinals, Bedpans|Continuous Passive Motion (CPM) Devices|Hospital Beds (Electric)|Hospital Beds (Manual)|External Infusion Pumps and/or Supplies|Negative Pressure Wound Therapy Pumps/Supplies|Neuromuscular Elect Stimulators (NMES)/Supplies|Support Surfaces: Pressure Reducing Beds/Mats/Pad… Does not accept assignmentParticipating since Feb 19, 2007

National Provider Directory

National Provider Directory
Tax ID family
Delta Medical Group Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1584489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678406400000",
    "number": "1073149373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19238",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724036603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 E MILLSAP RD STE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727036289",
            "telephone_number": "479-935-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-18",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A",
        "authorized_official_last_name": "FOLDEN",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-333-1230"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163732716",
            "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 Mar 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.