NPIMap

Organization Active NPI

Lifespring Women'S Healthcare PA

  • Obstetrics & Gynecology Physician
  • Bentonville, AR
National Provider Identifier
1164519450
Registry record updated Jul 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
LIFESPRING WOMEN'S HEALTHCARE PA
Practice address
1200 SE 28TH St
2
Bentonville, AR 72712-3881
Phone
(479) 271-0005
Fax
(479) 273-1427
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2013

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

Authorized official

Name
Dr. J Todd Hannah, M.D.
Title
Owner
Phone
(479) 271-0005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1200 SE 28TH St
2
Bentonville, AR 72712-3881

Mailing address

1200 SE 28TH St
2
Bentonville, AR 72712-3881
Phone (479) 271-0005

Other identifiers 2

IdentifierTypeStateIssuer
162837002MedicaidAR
5F652OtherARBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070123000090 AR Part B Supplier - Clinic/Group Practice 1254332083 Receives reassigned benefits from 9 practitioners
Practice locations: Bentonville, AR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2308420Lifespring Women'S Healthcare1200 SE 28TH Street Suite 2, Bentonville, AR 72712Provider-performed microscopyJul 28, 2026

National Provider Directory

National Provider Directory

Locations

1200 SE 28th St
Bentonville, AR 72712
Phone (479) 471-0005

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373241600000",
    "number": "1164519450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SE 28TH ST",
            "address_2": "2",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123881",
            "telephone_number": "479-271-0005",
            "fax_number": "473-273-1427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SE 28TH ST",
            "address_2": "2",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123881",
            "telephone_number": "479-271-0005",
            "fax_number": "479-273-1427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPRING WOMEN'S HEALTHCARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2013-07-08",
        "status": "A",
        "authorized_official_last_name": "HANNAH",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-271-0005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "162837002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5F652",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.