NPIMap

Individual provider Active NPI

Johnny Ross Paine, D.O

  • Adult Medicine Physician
  • Searcy, AR
National Provider Identifier
1295708428
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
R-3454 Issued in AR
Practice address
15 Silver Oak Dr
Searcy, AR 72143-4584
Phone
(972) 533-1767
Fax
(501) 279-1217
NPI assigned
Feb 8, 2006
Last updated
Feb 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L4621 TX
Adult Medicine Physician 207QA0505X 3902 OK
Adult Medicine Physician 207QA0505X R-3454 AR Primary

Addresses

Primary practice location

15 Silver Oak Dr
Searcy, AR 72143-4584

Mailing address

PO Box 639
Thiensville, WI 53092-0639
Phone (414) 247-9005

Other identifiers 4

IdentifierTypeStateIssuer
1203902MedicaidOK
197838902MedicaidTX
103756003MedicaidAR
197838901MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131219000174 AR Practitioner - Family Practice 7517903081 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 1983
Medicare assignment
May accept Medicare assignment
Group practices
White County Medical CenterGroup PAC ID 4880688654, 182 clinicians

Practice addresses (Care Compare)

Searcy, AR 72143
Phone (972) 533-1767

2900 Hawkins Dr
Searcy, AR 72143-4802
Phone (501) 278-2800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3902OKMDCounselor
L4621TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Health Group Current Accepting new patients
Choctaw Nation of Oklahoma Past Accepting new patients
White County Urgent Care Past Accepting new patients

Locations

2900 Hawkins Dr
Searcy, AR 72143
Phone (501) 278-2800

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Beebe Retirement Center, Inc.Beebe, AR, CCN 045304 Skilled nursing facility Adp of the SNF Aug 14, 2024
Spring Creek Health & RehabCabot, AR, CCN 045392 Skilled nursing facility Operational/Managerial Control Aug 28, 2024
The Crossing at Riverside Health and RehabilitationSearcy, AR, CCN 045209 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 28, 2024
Aug 28, 2024
The Blossoms at Oakdale Rehab & Nursing CenterJudsonia, AR, CCN 045418 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 1, 2024
Aug 1, 2024

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1295708428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "THIENSVILLE",
            "state": "WI",
            "postal_code": "530920639",
            "telephone_number": "414-247-9005",
            "fax_number": "414-247-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SILVER OAK DR",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "721434584",
            "telephone_number": "972-533-1767",
            "fax_number": "501-279-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAINE",
        "first_name": "JOHNNY",
        "middle_name": "ROSS",
        "name_prefix": "Mr.",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L4621",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "OK",
            "license": "3902",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AR",
            "license": "R-3454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1203902",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197838902",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103756003",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197838901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Searcy, AR

Sources for this page

Verify at the official NPI Registry.