Washington Regional Medical System
Organization Active NPI Neurological Surgery Physician · Fayetteville, AR
NPI 1104097500 · NPPES record last updated Dec 17, 2009
Key facts
- NPI
- 1104097500
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurological Surgery Physician 207T00000X
- Legal business name
- WASHINGTON REGIONAL MEDICAL SYSTEM
- Practice address
- 3336 N Futrall Dr
Fayetteville, AR 72703-4057 - Phone
- (479) 463-3000
- Fax
- (479) 469-3050
- NPI assigned
- Mar 13, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Daniel Eckels
- Title
- Senior Vice President/Cfo
- Phone
- (479) 463-1704
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 12
Practitioners 253
-
Mehmet S. Akdol, MD
-
Kacy V. Enloe, PA-C
-
Brandon Evans, MD
-
Steven Donald Graham, M.D.
-
Katie Leigh Halsell, APRN
-
Candace Jewel Harper, PAC
-
Jason Thomas Keech, DPT
-
David Luke Knox, MD
-
Felicia May, CNS
-
Sherrie Kay Montellano, PA-C
-
Michael W Morse, MD
-
Mark E Moss, MD
-
Brent P Peterson, DO
-
Thomas Kirk Rogerson, P.T.
-
Rebekah Sanchez, PA
-
Krista L Scott, NURSE PRACTITIONER
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Encompass Health Rehabilitation Hospital, a Partner of Washington Regi |
Hospital | 5% Or Greater Indirect Ownership Interest (50%) | Dec 31, 2007 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080630000683 | AR | Part B Supplier - Clinic/Group Practice | 8820995434 |
Receives reassigned benefits from 49 practitioners Practice locations: Fayetteville, AR |
National Provider Directory
Locations
3 E Appleby Rd
Ste 402
Fayetteville, AR 72703
Phone (479) 404-1250
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician |
207T00000X | Yes | ||
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 176277002 | Medicaid | AR |
Other names
- Northwest Arkansas Neuroscience Institute
Other providers in Fayetteville, AR
- Washington Regional Medical Center
- Washington Regional Medical Center
- Washington Regional Medical Center
- Washington Regional Medical Center
- Washington Regional Medical System
- Washington Regional Medical System
- Washington Regional Medical System
- Washington Regional Medical System
- Washington Regional Medical System
- Washington Regional Medical System
All providers in Fayetteville, AR · Neurological Surgery Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.