NPIMap

Individual provider Active NPI

Bobie Jo Widders, MD

  • Family Medicine Physician
  • Conway, AR
National Provider Identifier
1114556370
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-16783 Issued in AR
Practice address
2425 Dave Ward Dr Ste 401
Conway, AR 72034-8681
Phone
(501) 327-3824
NPI assigned
Apr 8, 2020
Last updated
Apr 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X E-16783 AR Primary

Addresses

Primary practice location

2425 Dave Ward Dr Ste 401
Conway, AR 72034-8681

Mailing address

2425 Dave Ward Dr Ste 401
Conway, AR 72034-8681
Phone (501) 329-3824

Other practice location 1

3201 Springhill Dr Ste 300
North Little Rock, AR 72117-2909
Phone (501) 753-4132

Other names 1

  • Bobie Jo Cooper Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240820001400 AR Practitioner - Family Practice 0143641555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bowlin-Cummins PAGroup PAC ID 5698725745, 8 clinicians

Practice addresses (Care Compare)

2425 Dave Ward Dr
Suite 401
Conway, AR 72034-8681
Phone (501) 329-3824

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-16783ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bowlin-Cummins PA Single Specialty CurrentSince Sep 1, 2024 Accepting new patients

Locations

2425 Dave Ward Dr
Ste 401
Conway, AR 72034
Phone (501) 329-3824

Organizations & group practices 1

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1114556370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 DAVE WARD DR STE 401",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348681",
            "telephone_number": "501-329-3824",
            "fax_number": "501-327-2957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 DAVE WARD DR STE 401",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348681",
            "telephone_number": "501-327-3824"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3201 Springhill Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "North Little Rock",
            "state": "AR",
            "postal_code": "721172909",
            "country_code": "US",
            "telephone_number": "501-753-4132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIDDERS",
        "first_name": "BOBIE",
        "middle_name": "JO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-16783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BOBIE",
            "last_name": "COOPER",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.