NPIMap

Organization Active NPI

Ozark Surgical Group

  • Surgery Physician
  • Mountain Home, AR
National Provider Identifier
1336155167
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
OZARK SURGICAL GROUP
Practice address
901 Burnett Dr
Mountain Home, AR 72653-2908
Phone
(870) 425-9120
NPI assigned
Aug 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Susan Marie Smith, CCS, CPC, CPMA, CGSC
Title
Coding & Billing Manager
Phone
(870) 425-9120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

901 Burnett Dr
Mountain Home, AR 72653-2908

Mailing address

901 Burnett Dr
Mountain Home, AR 72653-2908
Phone (870) 425-9120

Other identifiers 1

IdentifierTypeStateIssuer
101039002MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070426000280 AR Part B Supplier - Clinic/Group Practice 6901902642 Receives reassigned benefits from 9 practitioners
Practice locations: Mountain Home, AR; Salem, AR

National Provider Directory

National Provider Directory

Locations

901 Burnett Dr
Mountain Home, AR 72653
Phone (870) 425-9120

673 N Main St
Ste D
Salem, AR 72576
Phone (870) 425-9120

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/0005626

Practitioners & affiliated clinicians

Practitioners 11

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": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1336155167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 BURNETT DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532908",
            "telephone_number": "870-425-9120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 BURNETT DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532908",
            "telephone_number": "870-425-9120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARK SURGICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CODING & BILLING MANAGER",
        "authorized_official_telephone_number": "870-425-9120",
        "authorized_official_credential": "CCS, CPC, CPMA, CGSC"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101039002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.