Tommy Ray Mahan

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

3693 Hwy 92 W
Center Ridge, AR 72027

Phone

(501) 208-6938

NPI assigned

Mar 13, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331596800000",
    "number": "1285909036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15",
            "city": "CENTER RIDGE",
            "state": "AR",
            "postal_code": "720270015",
            "telephone_number": "501-208-6938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3693 HWY 92 W",
            "city": "CENTER RIDGE",
            "state": "AR",
            "postal_code": "72027",
            "telephone_number": "501-208-6938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHAN",
        "first_name": "TOMMY",
        "middle_name": "RAY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-13",
        "last_updated": "2012-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189358783",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Case Manager/Care Coordinator in Center Ridge, AR
• Providers in Center Ridge, AR by specialty
• Case Manager/Care Coordinator in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; 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.