Designing Health PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

E0546 Issued in AR

Legal business name

DESIGNING HEALTH PA

Doing business as

Main Street Medical

Practice address

2603 Main Dr
Suite 6
Fayetteville, AR 72704-5278

Phone

(479) 571-4325

Fax

(479) 571-4329

NPI assigned

Mar 10, 2009

Last updated

Apr 8, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Scott Fedosky, MD

Title

Physician

Phone

(479) 571-4325

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Main Street Medical Doing business as

Locations

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.

• Cathleen E Vandergriff, M.D

  • Family Medicine Physician
  • Broken Arrow, OK
  • NPI 1306967088
  NPD (past)

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

{
    "created_epoch": "1236643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396915200000",
    "number": "1356582035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 MAIN DR",
            "address_2": "SUITE 6",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727045278",
            "telephone_number": "479-571-4325",
            "fax_number": "479-571-4329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 MAIN DR",
            "address_2": "SUITE 6",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727045278",
            "telephone_number": "479-571-4325",
            "fax_number": "479-571-4329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESIGNING HEALTH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-10",
        "last_updated": "2014-04-08",
        "status": "A",
        "authorized_official_last_name": "FEDOSKY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "479-571-4325",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E2717",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": "E0546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES -  INDIVIDUAL NPI NUMBER",
            "identifier": "1710993654",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESIGNING HEALTH, PA MEDICAID ORGANIZATIONAL NUMBER",
            "identifier": "179094002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PERSONAL NUMBER",
            "identifier": "167302001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "5G182",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Department of Health and Human Services
• Department of Health and Human Services (Northwest Region Maternity)
• Department of Health and Human Services (Division of Health)
• Department of Health and Human Services (Division of Health)
• Nathan Deschenes
• Kinley Grace Despain
• Destiny Bound, LLC (NWABABIES and Designing HEALTH)
• Janet Kay Devore, APN, MNSC
• Logan Jerald Dewhitt, DPT
• Cynthia Anne Dewitt, LMT, CLT

• General Practice Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• General Practice Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.