NPIMap

Individual provider Active NPI

Jon M Berry, M.D.

  • Surgery Physician
  • Fayetteville, AR
National Provider Identifier
1124085469
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
E4061 Issued in AR
Practice address
3 E Appleby Rd Ste 401
Fayetteville, AR 72703-3163
Phone
(479) 404-2500
Fax
(479) 404-2501
NPI assigned
Apr 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X E4061 AR Primary

Addresses

Primary practice location

3 E Appleby Rd Ste 401
Fayetteville, AR 72703-3163

Mailing address

3 E Appleby Rd Ste 401
Fayetteville, AR 72703-3163
Phone (479) 404-2500

Other identifiers 1

IdentifierTypeStateIssuer
156509001MedicaidAR

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
I20040717000278 AR Practitioner - General Surgery 0143209601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Oklahoma College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3 E Appleby Rd
Suite 401
Fayetteville, AR 72703-3163
Phone (479) 404-2500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)14
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E4061ARMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System Current Accepting new patients
Washington Regional Medical System CurrentSince Jan 1, 2020 Accepting new patients
Washington Regional Medical System CurrentSince Jan 1, 2020 Accepting new patients
North Hills Surgery Center, LLC PastSince Oct 1, 2010 Accepting new patients
Washington Regional Medical System Past Accepting new patients

Locations

3 E Appleby Rd
Ste 401
Fayetteville, AR 72703
Phone (479) 404-2500

Interoperability endpoints

  • Direct secure messaging: jberry23104@washingtonregional.direct-ci.com
  • Direct secure messaging: jon.berry.p1@direct.fsa.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Washington Regional Medical CenterFayetteville, AR, CCN 040004 Hospital Corporate Director Jan 1, 2022
Washington Regional Medical Center Home HealthFayetteville, AR, CCN 047102 Home health agency Corporate Director Jan 1, 2022
Washington Regional HospiceFayetteville, AR, CCN 041500 Hospice Corporate Director Jan 1, 2022

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 1

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": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1124085469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 E APPLEBY RD STE 401",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033163",
            "telephone_number": "479-404-2500",
            "fax_number": "479-404-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 E APPLEBY RD STE 401",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033163",
            "telephone_number": "479-404-2500",
            "fax_number": "479-404-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "JON",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E4061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156509001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.