Individual provider Active NPI

Martin A Hannon, MD

  • Family Medicine Physician
  • Rogers, AR
National Provider Identifier
1124029624
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E3067 Issued in AR
Practice address
3730 S Pinnacle Hills Pkwy Ste 2
Rogers, AR 72758-8897
Phone
(479) 464-5599
Fax
(479) 464-5598
NPI assigned
Aug 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E3067 AR Primary

Addresses

Primary practice location

3730 S Pinnacle Hills Pkwy Ste 2
Rogers, AR 72758-8897

Mailing address

PO Box 1523
Fayetteville, AR 72702-1523
Phone (479) 571-6038

Other identifiers 1

IdentifierTypeStateIssuer
146500001MedicaidAR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address martin.hannon@mana.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040615001748 AR Practitioner - Family Practice 4789668906 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medical Associates of Northwest Arkansas, PAGroup PAC ID 3678542073, 102 clinicians

Practice addresses (Care Compare)

3344 N Futrall Dr
Fayetteville, AR 72703-4057
Phone (479) 521-8200

3383 N Mana CT
Fayetteville, AR 72703-4965

3730 S Pinnacle Hills Pkwy
Rogers, AR 72758-8897

Hospital & facility affiliations

  • Northwest Home Health Home health agency, Springdale, AR, CCN 047020
  • Northwest Medical Center-Springdale Hospital, Springdale, AR, CCN 040022
  • Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates of Northwest Arkansas, PA Family Medicine Current Accepting new patients
Medical Associates of Northwest Arkansas PA Family Medicine CurrentSince Apr 15, 2018 Accepting new patients
Northwest Benton County Physician Services LLC Family Medicine CurrentSince Jun 1, 2008 Accepting new patients
Medical Associates of Northwest Arkansas PA Family Medicine CurrentSince Apr 15, 2018 Accepting new patients
Medical Associates of Northwest Arkansas PA Family Medicine Past Accepting new patients
Medical Associates of Northwest Arkansas PA Family Medicine Past Accepting new patients
Medical Associates of Northwest Arkansas PA Family Medicine Past Accepting new patients
Hot Springs MRI Center Past Accepting new patients
Sparks Medical Foundation Family Medicine Past Accepting new patients
Medical Associates of Northwest Arkansas PA Family Medicine Past Accepting new patients
CHI St. Vincent Medical Group Hot Springs Family Medicine PastSince Mar 1, 2008 Accepting new patients

Locations

101 Sun Meadow Dr
Centerton, AR 72719
Phone (479) 273-1426

3344 N Futrall Dr
Fayetteville, AR 72703
Phone (479) 582-7213

3730 S Pinnacle Hills Pkwy
Ste 2
Rogers, AR 72758
Phone (479) 464-5599

803 Quandt Ave
Springdale, AR 72764
Phone (479) 751-9236

Interoperability endpoints

  • Direct secure messaging: martin.hannon@mana.eclinicaldirectplus.com

Organizations & group practices 11

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 3

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1124029624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1523",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727021523",
            "telephone_number": "479-571-6038",
            "fax_number": "479-582-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3730 S PINNACLE HILLS PKWY STE 2",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588897",
            "telephone_number": "479-464-5599",
            "fax_number": "479-464-5598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNON",
        "first_name": "MARTIN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E3067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146500001",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "martin.hannon@mana.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "martin.hannon@mana.eclinicaldirectplus.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3730 S Pinnacle Hills Pkwy Ste 2",
            "city": "Rogers",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727588897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

Verify at the official NPI Registry.