Individual provider Active NPI

Yong S Kwon, M.D.

  • Surgery Physician
  • Fayetteville, AR
National Provider Identifier
1265544035
Registry record updated Sep 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
E-6941 Issued in AR
Practice address
1695 E Rainforest Rd
Fayetteville, AR 72703-5385
Phone
(479) 445-6460
Fax
(479) 445-6719
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X E-6941 AR Primary

Addresses

Primary practice location

1695 E Rainforest Rd
Fayetteville, AR 72703-5385

Mailing address

1695 E Rainforest Rd
Suite 5
Fayetteville, AR 72703-5385
Phone (479) 445-6460

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111010000346 AR Practitioner - General Surgery 1052443470 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Washington School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Roller Weight Loss Institute, Inc.Group PAC ID 0446398770, 24 clinicians

Practice addresses (Care Compare)

1695 E Rainforest Rd
Fayetteville, AR 72703-5385
Phone (479) 445-6460

Hospital & facility affiliations

  • Northwest Medical Center-Springdale Hospital, Springdale, AR, CCN 040022
  • Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux38
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-6941ARMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Roller Weight Loss Institute,Inc. Surgery CurrentSince Aug 20, 2011 Accepting new patients
Roller Weight Loss Institute Inc Surgery CurrentSince Aug 20, 2011 Accepting new patients
Northwest Arkansas Hospitals, LLC Past Accepting new patients
Northwest Physicians LLC Past Accepting new patients

Locations

1695 E Rainforest Rd
Ste 5
Fayetteville, AR 72703
Phone (479) 757-4725

1695 E Rainforest Rd
Ste 2
Fayetteville, AR 72703
Phone (479) 445-6460

1695 E Rainforest Rd
Fayetteville, AR 72703
Phone (479) 445-6460

609 W Maple Ave
Fl 6
Springdale, AR 72764
Phone (479) 757-2600

Interoperability endpoints

  • Direct secure messaging: rollerweightlossandadvancedsurgery.yongkwon@118248.advancedmd-direct.com

Organizations & group practices 4

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 2

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474329600000",
    "number": "1265544035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 E RAINFOREST RD",
            "address_2": "SUITE 5",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035385",
            "telephone_number": "479-445-6460",
            "fax_number": "479-445-6719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 E RAINFOREST RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035385",
            "telephone_number": "479-445-6460",
            "fax_number": "479-445-6719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWON",
        "first_name": "YONG",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E-6941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.