Active NPI
Charles Paul Sisco, M.D.
- Allergy & Immunology (Internal Medicine) Physician
- Fayetteville, AR
National Provider Identifier
1124021639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology (Internal Medicine) Physician
- License
- C4144
- Practice address
- 17994 Habberton Rd
Fayetteville, AR 72703-9117 - Phone
- (479) 445-6550
- NPI assigned
- May 31, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology (Internal Medicine) Physician | 207RA0201X | C4144 | AR | Primary |
Addresses
Primary practice location
17994 Habberton Rd
Fayetteville, AR 72703-9117
Mailing address
PO Box 65
Springdale, AR 72765-0065
Phone (479) 445-6550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C4144 | AR | MD | Allergy & Immunology (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184284800000",
"number": "1124021639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 65",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727650065",
"telephone_number": "479-445-6550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17994 HABBERTON RD",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727039117",
"telephone_number": "479-445-6550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SISCO",
"first_name": "CHARLES",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-31",
"last_updated": "2007-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207RA0201X",
"taxonomy_group": "",
"desc": "Internal Medicine, Allergy & Immunology",
"state": "AR",
"license": "C4144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.