NPIMap

Organization Active NPI

Bentonville Pediatrics

  • Pediatrics Physician
  • Bentonville, AR
National Provider Identifier
1356319164
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
BENTONVILLE PEDIATRICS
Practice address
2719 SE I St
Bentonville, AR 72712-3996
Phone
(479) 273-5437
Fax
(479) 273-9932
NPI assigned
Mar 8, 2006
Last updated
Oct 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Authorized official

Name
Mr. Jason B Foster, M.D.NPI 1184692683
Title
Owner
Phone
(479) 273-5437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

2719 SE I St
Bentonville, AR 72712-3996

Mailing address

PO Box 9178
Russellville, AR 72811-9178
Phone (479) 968-4273

Other identifiers 2

IdentifierTypeStateIssuer
146796002MedicaidAR
5C844OtherARARK. BCBS

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
04D1002649Bentonville Pediatrics2719 SE I St, Bentonville, AR 72712Certificate of waiverAug 11, 2026

National Provider Directory

National Provider Directory

Locations

2719 SE I St
Bentonville, AR 72712
Phone (479) 273-5437

Interoperability endpoints

  • Direct secure messaging: bentonvillepediatrics@org234.direct.charmhealth.com

Practitioners & affiliated clinicians

Practitioners 11

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": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728604800000",
    "number": "1356319164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9178",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728119178",
            "telephone_number": "479-968-4273",
            "fax_number": "479-968-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2719 SE I ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123996",
            "telephone_number": "479-273-5437",
            "fax_number": "479-273-9932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENTONVILLE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2024-10-11",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-273-5437",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146796002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARK. BCBS",
            "identifier": "5C844",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.