NPIMap

Organization Active NPI

Washington Regional Medical Center

  • General Acute Care Hospital
  • Fayetteville, AR
National Provider Identifier
1083609150
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
AR4099 Issued in AR
Legal business name
WASHINGTON REGIONAL MEDICAL CENTER
Practice address
3215 N Northhills Blvd
Fayetteville, AR 72703-4007
Phone
(479) 463-5000
NPI assigned
Sep 15, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dan Eckels
Title
Sr. VP & Cfo
Phone
(479) 463-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X AR4099 AR Primary

Addresses

Primary practice location

3215 N Northhills Blvd
Fayetteville, AR 72703-4007

Mailing address

3215 N Northhills Blvd
Fayetteville, AR 72703-4007
Phone (479) 463-5000

Other identifiers 1

IdentifierTypeStateIssuer
AR4099OtherARSTATE LICENSURE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20020912000021 AR Part A Provider - Hospital 7214844034 Practice locations: Fayetteville, AR; Springdale, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083609150. Details of each certification follow.

Hospital certification: CCN 040004

Legal name
WASHINGTON REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 1, 2023
Beds
425
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Enrollment address
3215 N Northhills Blvd
Fayetteville, AR 72703-4424
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Washington Regional Medical CenterCCN 040004 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

12 E Appleby Rd
Ste 101
Fayetteville, AR 72703
Phone (479) 463-4444

2683 N Quality Ln
Fayetteville, AR 72703
Phone (479) 463-1840

3 E Appleby Rd
Ste 104
Fayetteville, AR 72703
Phone (479) 404-1050

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jon Michael Berry Individual Corporate DirectorDirector Jan 1, 2022
M Gareth Eck Individual Corporate DirectorBoard Member Jan 1, 2015
Thomas Olmstead Individual Corporate OfficerSr VP, General Counsel Nov 17, 2005
Drew Rodgers Individual Corporate Director Jan 1, 2024
Stacey Hanby Individual Corporate DirectorDirector Jan 1, 2022
Marshall Saviers Individual Corporate DirectorVice Chair Jan 1, 2023
James L Shackelford Individual Corporate OfficerPresident and Chief Executive of Sep 1, 2017
Operational/Managerial ControlPresident and Chief Executive of Jan 1, 2017 100%
Anne O'Leary-Kelly Individual Corporate DirectorDirector Jan 1, 2022
Dennis Charles Burrows Individual Corporate OfficerChief Accounting Officer Mar 1, 2023
Jim Daly Individual Corporate OfficerChief Information Officer Jan 1, 2024
David Grady Ratcliff Individual Corporate OfficerChief Medical Officer Jul 1, 2005
Greg Lee Individual Corporate DirectorBoard Chairman Jan 1, 2016
Birch Wright Individual Corporate OfficerChief Operating Officer, Adminis Aug 18, 2020
W-2 Managing EmployeeChief Operating Officer, Adminis Aug 18, 2020
Britton B Lott Individual Corporate Director Jan 1, 2024
Kristy Spruell Individual Corporate OfficerChief Compliance Officer Jan 1, 2017
Neal Pendergraft Individual Corporate DirectorSecretary Jan 1, 2018
Meredith Green Individual Corporate OfficerChief Nursing Officer Jan 1, 2017
George Gearhart Individual Corporate DirectorChair Jan 1, 2020
Lucas K Campbell Individual Corporate OfficerSVP Clinical Enterprise & Strate Jan 1, 2025

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Encompass Health Rehabilitation Hospital, a Partner of Washington RegiFayetteville, AR, CCN 043032 Hospital 5% Or Greater Indirect Ownership Interest (50%) Dec 31, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 205

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.

View all 205

Affiliated clinicians 498

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 498

NPI Registry JSON

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083609150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3215 N NORTHHILLS BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034007",
            "telephone_number": "479-463-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3215 N NORTHHILLS BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034007",
            "telephone_number": "479-463-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ECKELS",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "SR. VP & CFO",
        "authorized_official_telephone_number": "479-463-5000"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "AR",
            "license": "AR4099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSURE",
            "identifier": "AR4099",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.