Ryan David Mantooth, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

E-13154 Issued in AR

Practice address

3215 N North Hills Blvd.
Fayetteville, AR 72703

Phone

(479) 463-7102

Fax

(479) 463-5987

NPI assigned

Apr 10, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AL, AR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Emergency Medicine

Education

University of Arkansas College of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Washington Regional Medical SystemGroup PAC ID 8820995434, 238 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rmantooth34613@washingtonregional.direct-ci.com

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

• Washington Regional Medical System

  dba Washington Regional Hospital Medicine Group

  • Hospitalist Physician
  • Fayetteville, AR
  • NPI 1306801485
  Medicare reassignment Care Compare group NPD
• Paragon Contracting Services LLC

  • Emergency Medicine Physician
  • Birmingham, AL
  • NPI 1225071459
  Medicare reassignment NPD
• Washington Regional Medical System

  dba Washington Regional Family Clinic - Farmington

  • Family Medicine Physician
  • Farmington, AR
  • NPI 1275839011
  NPD
• Washington Regional Medical System

  dba Washington Regional Psychiatric Clinic

  • Geriatric Psychiatry Physician
  • Fayetteville, AR
  • NPI 1366408973
  NPD
• Washington Regional Medical System

  • Infectious Disease Physician
  • Fayetteville, AR
  • NPI 1346175387
  NPD (past)

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

• Washington Regional Medical Center

  • General Acute Care Hospital
  • Fayetteville, AR
  • NPI 1083609150
  Care Compare affiliation

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1114450822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727451900",
            "telephone_number": "479-473-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3215 N NORTH HILLS BLVD.",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-463-7102",
            "fax_number": "479-463-5987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTOOTH",
        "first_name": "RYAN",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-10",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E-13154",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "MD.37708",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Mallard
• Matthew Layne Mallory, M.D.
• Mana Anesthesia Services LLC
• Sarah M Mann, NP
• Hannah Mantooth
• Crystal Marie Mapes, LPC
• Ana C Mar Leon
• Byron Michael Marciniak, DO
• Dorothy Marcy
• Marie W. Wood PHD Inc

• Emergency Medicine Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Emergency Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.