NPIMap

Organization Active NPI

Washington Regional Medical System

Doing business as Northwest Arkansas Neuroscience Institute

  • Neurological Surgery Physician
  • Fayetteville, AR
National Provider Identifier
1104097500
Registry record updated Dec 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
WASHINGTON REGIONAL MEDICAL SYSTEM
Doing business as
Northwest Arkansas Neuroscience Institute
Practice address
3336 N Futrall Dr
Fayetteville, AR 72703-4057
Phone
(479) 463-3000
Fax
(479) 469-3050
NPI assigned
Mar 13, 2008
Last updated
Dec 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2009

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

Authorized official

Name
Mr. Daniel Eckels
Title
Senior Vice President/Cfo
Phone
(479) 463-1704

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X Primary
Clinical Neurophysiology Physician 2084N0600X

Addresses

Primary practice location

3336 N Futrall Dr
Fayetteville, AR 72703-4057

Mailing address

12 E Appleby Rd
Clinic Administration
Fayetteville, AR 72703-3901
Phone (479) 463-1704

Other identifiers 1

IdentifierTypeStateIssuer
176277002MedicaidAR

Other names 1

  • Northwest Arkansas Neuroscience Institute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080630000683 AR Part B Supplier - Clinic/Group Practice 8820995434 Receives reassigned benefits from 49 practitioners
Practice locations: Fayetteville, AR

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory

Locations

3336 N Futrall Dr
Fayetteville, AR 72703
Phone (479) 444-8827

Ownership & related parties

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 50

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 50

NPI Registry JSON

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

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261008000000",
    "number": "1104097500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "CLINIC ADMINISTRATION",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-1704",
            "fax_number": "479-463-7864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3336 N FUTRALL DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034057",
            "telephone_number": "479-463-3000",
            "fax_number": "479-469-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-13",
        "last_updated": "2009-12-17",
        "status": "A",
        "authorized_official_last_name": "ECKELS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT/CFO",
        "authorized_official_telephone_number": "479-463-1704",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176277002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Arkansas Neuroscience Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.