Justin Bean

Individual provider Active NPI Case Manager/Care Coordinator · Dierks, AR

NPI 1336848860 · NPPES record last updated Feb 23, 2023

Key facts

NPI
1336848860
Entity type
Individual (NPI type 1)
Primary specialty
Case Manager/Care Coordinator 171M00000X
Practice address
1124 Main Ave
Dierks, AR 71833-9421
Phone
(870) 784-0884
NPI assigned
Feb 23, 2023
Sex
Male
Sole proprietor
No

Organizations & group practices 1

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

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Impact Counseling Clinic, Incorporated Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25972/brand/1/csg/1/fhir/r4

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Yes

Addresses

Primary practice location

1124 Main Ave
Dierks, AR 71833-9421

Mailing address

PO Box 575
Dierks, AR 71833-0575

Other providers in Dierks, AR

All providers in Dierks, AR · Case Manager/Care Coordinator in Arkansas

Sources for this page

Verify at the official NPI Registry.