Organization Active NPI

Apex Medical LLC

Doing business as Rostollan Family Practce, Aesthetics, and Wellness

  • General Practice Physician
  • Mena, AR
National Provider Identifier
1306641550
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
APEX MEDICAL LLC
Doing business as
Rostollan Family Practce, Aesthetics, and Wellness
Rostollan Family Practice, Aesthetics, and Wellness
Practice address
403 Morrow St N
Mena, AR 71953-4324
Phone
(918) 720-4957
NPI assigned
Feb 13, 2025
Last updated
Feb 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
APEX MEDICAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Authorized official

Name
Mr. Donald R Brown Jr.
Title
President/Ceo
Phone
(918) 720-4957

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

403 Morrow St N
Mena, AR 71953-4324

Mailing address

4312 S Retana Ave
Broken Arrow, OK 74011-1397
Phone (918) 720-4957

Other names 2

  • Rostollan Family Practce, Aesthetics, and Wellness Doing business as
  • Rostollan Family Practice, Aesthetics, and Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250701004850 AR Part B Supplier - Clinic/Group Practice 2365955481 Receives reassigned benefits from 1 practitioner
Practice locations: Mena, AR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2319161Rostollan Family Practice, Aesthetics & Wellness403 N Morrow Street, Suite D, Mena, AR 71953Certificate of waiverFeb 24, 2027

National Provider Directory

National Provider Directory
Part of
Apex Medical LLC

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1739404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1306641550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4312 S RETANA AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740111397",
            "telephone_number": "918-720-4957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 MORROW ST N",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719534324",
            "telephone_number": "918-720-4957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APEX MEDICAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "APEX MEDICAL LLC",
        "enumeration_date": "2025-02-13",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "918-720-4957",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rostollan Family Practce, Aesthetics, and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rostollan Family Practice, Aesthetics, and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mena, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.