Active NPI
Total Wound Care of Arkansas,LLC
- Internal Medicine Physician
- Fayetteville, AR
National Provider Identifier
1205655008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- TOTAL WOUND CARE OF ARKANSAS,LLC
- Practice address
- 4250 N Venetian LN
Fayetteville, AR 72703-5077 - Phone
- (405) 246-0811
- Fax
- (405) 546-5801
- NPI assigned
- Oct 8, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Tad Burgess
- Title
- Ceo/Owner
- Phone
- (405) 659-6993
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
4250 N Venetian LN
Fayetteville, AR 72703-5077
Mailing address
1900 NW Expressway Ste 800
Oklahoma City, OK 73118-1804
Phone (405) 246-0811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250311003075 | AR | Part B Supplier - Clinic/Group Practice | 3375064918 |
Receives reassigned benefits from 10 practitioners Practice locations: Fayetteville, AR |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 10
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": "1728345600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1747785600000",
"number": "1205655008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 NW EXPRESSWAY STE 800",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731181804",
"telephone_number": "405-246-0811",
"fax_number": "405-546-5801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4250 N VENETIAN LN",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727035077",
"telephone_number": "405-246-0811",
"fax_number": "405-546-5801"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TOTAL WOUND CARE OF ARKANSAS,LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-10-08",
"last_updated": "2025-05-21",
"certification_date": "2025-05-21",
"status": "A",
"authorized_official_last_name": "BURGESS",
"authorized_official_first_name": "TAD",
"authorized_official_title_or_position": "CEO/OWNER",
"authorized_official_telephone_number": "405-659-6993",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; 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.