NPIMap

Organization Active NPI

Ozark Regional Vein Center, LLC

  • Diagnostic Radiology Physician
  • Rogers, AR
National Provider Identifier
1295089605
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
C-8120 Issued in AR
Legal business name
OZARK REGIONAL VEIN CENTER, LLC
Practice address
5433 W Walsh LN Ste 101
Rogers, AR 72758-8946
Phone
(479) 464-8346
NPI assigned
Nov 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Authorized official

Name
Mr. Rondall Kevin Haney, MDNPI 1770525594
Title
Owner
Phone
(479) 464-8346

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X C-8120 AR Primary

Addresses

Primary practice location

5433 W Walsh LN Ste 101
Rogers, AR 72758-8946

Mailing address

PO Box 667
Wichita, KS 67201-0667
Phone (479) 464-8346

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130104000068 AR Part B Supplier - Clinic/Group Practice 0244483089 Receives reassigned benefits from 7 practitioners
Practice locations: Rogers, AR

National Provider Directory

National Provider Directory

Locations

209 Carter St
Berryville, AR 72616
Phone (479) 636-9393

5433 W Walsh Ln
Rogers, AR 72758
Phone (479) 464-8346

5433 W Walsh Ln
Ste 101
Rogers, AR 72758
Phone (479) 464-8346

Practitioners & affiliated clinicians

Practitioners 7

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": "1352246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1295089605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 667",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672010667",
            "telephone_number": "479-464-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5433 W WALSH LN STE 101",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588946",
            "telephone_number": "479-464-8346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARK REGIONAL VEIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-07",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "HANEY",
        "authorized_official_first_name": "RONDALL",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-464-8346",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AR",
            "license": "C-8120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; 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.

Verify at the official NPI Registry.