Northwest Arkansas Podiatry Center, Inc.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

193 Issued in AR

Legal business name

NORTHWEST ARKANSAS PODIATRY CENTER, INC.

Practice address

125 W Sunbridge Dr
Suite 1
Fayetteville, AR 72703-1899

Phone

(479) 251-9200

NPI assigned

Feb 15, 2007

Last updated

Jan 3, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Phetsamone Peter Xaysanasy, DPMNPI 1063456184

Title

Owner

Phone

(479) 251-9200

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• NWA Podiatry Center Inc. Other name

Locations

Practitioners 1

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.

• Phetsamone Peter Xaysanasy, D.P.M.

  • Podiatrist
  • Fayetteville, AR
  • NPI 1063456184
  Authorized official Same address or phone

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294012800000",
    "number": "1194868281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 W SUNBRIDGE DR",
            "address_2": "SUITE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031899",
            "telephone_number": "479-251-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 W SUNBRIDGE DR",
            "address_2": "SUITE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031899",
            "telephone_number": "479-251-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ARKANSAS PODIATRY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2011-01-03",
        "status": "A",
        "authorized_official_last_name": "XAYSANASY",
        "authorized_official_first_name": "PHETSAMONE",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-251-9200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AR",
            "license": "193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146684748",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "5C648",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NWA Podiatry Center Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Podiatrist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Podiatrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; 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.