NPIMap

Organization Active NPI

Monfee Medical Clinic

  • Family Medicine Physician
  • Russellville, AR
National Provider Identifier
1154350213
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C6448 Issued in AR
Legal business name
MONFEE MEDICAL CLINIC
Practice address
3812 W. Main St.
Russellville, AR 72811
Phone
(479) 968-1245
Fax
(479) 968-4137
NPI assigned
Jul 1, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Courtney Ayn Duvall
Title
Billing Manager
Phone
(479) 967-7044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C6448 AR Primary

Addresses

Primary practice location

3812 W. Main St.
Russellville, AR 72811

Mailing address

3812 W. Main St.
Russellville, AR 72811
Phone (479) 968-1245

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080430000739 AR Part B Supplier - Clinic/Group Practice 4385723402 Receives reassigned benefits from 3 practitioners
Practice locations: Russellville, AR

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DDAJAD

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154350213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 W. MAIN ST.",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "72811",
            "telephone_number": "479-968-1245",
            "fax_number": "479-968-4137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3812 W. MAIN ST.",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "72811",
            "telephone_number": "479-968-1245",
            "fax_number": "479-968-4137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONFEE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUVALL",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "AYN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "479-967-7044",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C6448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.