NPIMap

Organization Active NPI

Monticello Ess LLC

  • Emergency Medicine Physician
  • Monticello, AR
National Provider Identifier
1184010753
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MONTICELLO ESS LLC
Practice address
778 Scogin Dr
Monticello, AR 71655-5729
Phone
(870) 367-2411
NPI assigned
Apr 10, 2015
Last updated
Oct 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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

Authorized official

Name
Mr. Ron Weiss
Title
Ceo
Phone
(866) 931-8882

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

778 Scogin Dr
Monticello, AR 71655-5729

Mailing address

17304 Preston Rd
Suite 1400
Dallas, TX 75252-5618
Phone (866) 931-8882

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150519002625 AR Part B Supplier - Clinic/Group Practice 4880914639 Receives reassigned benefits from 123 practitioners
Practice locations: Monticello, AR

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 123

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.

View all 123

NPI Registry JSON

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

{
    "created_epoch": "1428624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569974400000",
    "number": "1184010753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17304 PRESTON RD",
            "address_2": "SUITE 1400",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752525618",
            "telephone_number": "866-931-8882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "778 SCOGIN DR",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716555729",
            "telephone_number": "870-367-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTICELLO ESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-10",
        "last_updated": "2019-10-02",
        "status": "A",
        "authorized_official_last_name": "WEISS",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "866-931-8882",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; 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.