NPIMap

Individual provider Active NPI

Stanley Wayne Burleson, MD

  • Family Medicine Physician
  • De Witt, AR
National Provider Identifier
1295839397
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C-5377 Issued in AR
Practice address
705 W 16TH St
Dewitt, AR 72042
Phone
(870) 946-1326
Fax
(870) 946-4335
NPI assigned
Sep 11, 2006
Last updated
Mar 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C-5377 AR Primary

Addresses

Primary practice location

705 W 16TH St
Dewitt, AR 72042

Mailing address

PO Box 352
Dewitt, AR 72042
Phone (870) 946-1326

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
I20080623000594 AR Practitioner - Family Practice 4688766181 Reassigns benefits to 1 organization
Practice locations: Dewitt, AR

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

705 W 16TH St
De Witt, AR 72042-3414
Phone (870) 946-3571

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dewitt Hospital & Nursing Home, Inc. CurrentSince Jul 1, 1987 Accepting new patients

Locations

1641 S Whitehead Dr
Dewitt, AR 72042
Phone (870) 946-2971

705 W 16th St
Dewitt, AR 72042
Phone (870) 946-1326

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Dewitt Hospital & Nursing Home IncDewitt, AR, CCN 040783 Hospital Corporate Director Mar 28, 2002
Dewitt Nursing HomeDewitt, AR, CCN 045365 Skilled nursing facility Corporate Director Mar 28, 2002
Dewitt Hospital & Nursing Home IncDewitt, AR, CCN 043486 Rural health clinic Corporate Director Mar 28, 2002

Owned or controlled facilities with NPI records 2

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

Organizations & group practices 2

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 4

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": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1295839397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 352",
            "city": "DEWITT",
            "state": "AR",
            "postal_code": "72042",
            "telephone_number": "870-946-1326",
            "fax_number": "870-946-4335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 W 16TH ST",
            "city": "DEWITT",
            "state": "AR",
            "postal_code": "72042",
            "telephone_number": "870-946-1326",
            "fax_number": "870-946-4335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURLESON",
        "first_name": "STANLEY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C-5377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in De Witt, AR

Sources for this page

Verify at the official NPI Registry.