NPIMap

Organization Active NPI

Washington Regional Medical System

Doing business as Cardiovascular Surgical Clinic of Northwest Arkansas Washington Regional

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Fayetteville, AR
National Provider Identifier
1356842884
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
WASHINGTON REGIONAL MEDICAL SYSTEM
Doing business as
Cardiovascular Surgical Clinic of Northwest Arkansas Washington Regional
Cardiovascular Surgical of Northwest Arkansas Washington Regional
Practice address
3276 N Northhills Blvd
Fayetteville, AR 72703-4005
Phone
(479) 587-1114
Fax
(479) 587-1119
NPI assigned
Feb 21, 2018
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Daniel R Eckels
Title
Cfo
Phone
(479) 463-2825

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

3276 N Northhills Blvd
Fayetteville, AR 72703-4005

Mailing address

54 W Sunbridge Dr
Fayetteville, AR 72703-1822
Phone (479) 463-2597

Other names 2

  • Cardiovascular Surgical Clinic of Northwest Arkansas Washington Regional Doing business as
  • Cardiovascular Surgical of Northwest Arkansas Washington Regional Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040519000766 AR Part B Supplier - Clinic/Group Practice 8820995434 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fayetteville, AR; Springdale, AR
O20100130000001 AR Part B Supplier - Clinic/Group Practice 8820995434 Receives reassigned benefits from 117 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springdale, AR; Fayetteville, AR; Harrison, AR; Lincoln, AR; Lowell, AR; Siloam Springs, AR; Berryville, AR; Bentonville, AZ…

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

National Provider Directory

National Provider Directory

Locations

54 W Sunbridge Dr
Fayetteville, AR 72703
Phone (479) 435-4207

Practitioners & affiliated clinicians

Practitioners 4

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": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1356842884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 W SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031822",
            "telephone_number": "479-463-2597",
            "fax_number": "479-463-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3276 N NORTHHILLS BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034005",
            "telephone_number": "479-587-1114",
            "fax_number": "479-587-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "ECKELS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "479-463-2825"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardiovascular Surgical Clinic of Northwest Arkansas Washington Regional",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cardiovascular Surgical of Northwest Arkansas Washington Regional",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.