Individual provider Active NPI

Antoinette Lynn Hartman, APN

  • Nurse Practitioner
  • Fayetteville, AR
National Provider Identifier
1215972252
Registry record updated Apr 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AO1924 Issued in AR
Practice address
12 E Appleby Rd
Ste 101
Fayetteville, AR 72703-3901
Phone
(479) 463-4444
Fax
(479) 463-4499
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AO1924 AR Primary

Addresses

Primary practice location

12 E Appleby Rd
Ste 101
Fayetteville, AR 72703-3901

Mailing address

12 E Appleby Rd
Ste 101
Fayetteville, AR 72703-3901
Phone (479) 463-4444

Other identifiers 1

IdentifierTypeStateIssuer
5Y873OtherARBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060823000402 AR Practitioner - Nurse Practitioner 5799788287 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Washington Regional Medical SystemGroup PAC ID 8820995434, 238 clinicians

Practice addresses (Care Compare)

12 E Appleby Rd
Suite 101
Fayetteville, AR 72703-3928
Phone (479) 463-4444

Hospital & facility affiliations

  • Elite Home Health Home health agency, Springdale, AR, CCN 047346
  • Enhabit Home Health Home health agency, Springdale, AR, CCN 047170
  • Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004
  • Northwest Medical Center-Springdale Hospital, Springdale, AR, CCN 040022
  • Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AO1924ARMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System CurrentSince Apr 1, 2006 Accepting new patients
Washington Regional Medical System CurrentSince Apr 1, 2006 Accepting new patients
Washington Regional Medical System Past Accepting new patients

Locations

3211 N Northhills Blvd
Ste 210
Fayetteville, AR 72703
Phone (479) 463-4444

12 E Appleby Rd
Ste 101
Fayetteville, AR 72703
Phone (479) 463-4444

Interoperability endpoints

  • Direct secure messaging: ahartman31123@washingtonregional.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303689600000",
    "number": "1215972252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "STE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-4444",
            "fax_number": "479-463-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "STE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-4444",
            "fax_number": "479-463-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTMAN",
        "first_name": "ANTOINETTE",
        "middle_name": "LYNN",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2011-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "AO1924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5Y873",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.