NPIMap

Individual provider Active NPI

Dustin K Wixson, CRNA

  • Anesthesiology Physician
  • Little Rock, AR
National Provider Identifier
1114022209
Registry record updated May 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
C01501 Issued in AR
Practice address
9601 Interstate 630 Exit 7
Little Rock, AR 72205-7202
Phone
(501) 202-2093
NPI assigned
Sep 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X C01501 AR Primary

Addresses

Primary practice location

9601 Interstate 630 Exit 7
Little Rock, AR 72205-7202

Mailing address

11001 Executive Center Dr
Suite 200
Little Rock, AR 72211-4316

Other identifiers 1

IdentifierTypeStateIssuer
159969001MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050318000480 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 3072564970 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
White River Health System, Inc.Group PAC ID 0143134270, shared by 36 NPIs, 190 clinicians
White River Health Anesthesia Service Group, Inc.Group PAC ID 3173042397, 23 clinicians

Practice addresses (Care Compare)

1710 Harrison St
Batesville, AR 72501-7303

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
C01501ARMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
White River Health System, Inc. Current Accepting new patients
White River Health System, Inc. CurrentSince Jun 20, 2021 Accepting new patients
White River Health System, Inc. Anesthesiology CurrentSince Nov 30, 2015 Accepting new patients
White River Health Anesthesia Service Group, Inc. CurrentSince Apr 1, 2025 Accepting new patients
Arkansas Anesthesia Network Services LLC Anesthesiology Past Accepting new patients

Locations

1710 Harrison St
Ste A
Batesville, AR 72501
Phone (870) 262-3280

1710 Harrison St
Batesville, AR 72501
Phone (870) 262-1240

2106 E Main St
Mountain View, AR 72560
Phone (870) 262-5056

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210896000000",
    "number": "1114022209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DR",
            "address_2": "SUITE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9601 INTERSTATE 630 EXIT 7",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057202",
            "telephone_number": "501-202-2093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIXSON",
        "first_name": "DUSTIN",
        "middle_name": "K",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2008-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "C01501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159969001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; 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.