Organization Active NPI

Cornerstone Family Clinic LLC

  • Family Medicine Physician
  • Van Buren, AR
National Provider Identifier
1164630380
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CORNERSTONE FAMILY CLINIC LLC
Practice address
14 Gothic Ridge Rd
Van Buren, AR 72956-6565
Phone
(479) 474-1100
Fax
(479) 474-0069
NPI assigned
May 19, 2007
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
Robert Wendell Ross, M.D.
Title
Owner
Phone
(479) 474-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

14 Gothic Ridge Rd
Van Buren, AR 72956-6565

Mailing address

14 Gothic Ridge Rd
Van Buren, AR 72956-6565
Phone (479) 474-1100

National Provider Directory

National Provider Directory

Locations

605 Heather Ln
Alma, AR 72921
Phone (479) 407-6051

2020 Chestnut St
Ste 107
Van Buren, AR 72956
Phone (479) 474-8005

2010 Chestnut St
Ste D
Van Buren, AR 72956
Phone (479) 471-4445

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1179532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164630380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 GOTHIC RIDGE RD",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729566565",
            "telephone_number": "479-474-1100",
            "fax_number": "479-474-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 GOTHIC RIDGE RD",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729566565",
            "telephone_number": "479-474-1100",
            "fax_number": "479-474-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE FAMILY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "WENDELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-474-1100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Buren, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.