NPIMap

Organization Active NPI

Washington Regional Medical System

Doing business as Washington Regional Psychiatric Clinic

  • Geriatric Psychiatry Physician
  • Fayetteville, AR
National Provider Identifier
1366408973
Registry record updated Sep 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
Legal business name
WASHINGTON REGIONAL MEDICAL SYSTEM
Doing business as
Washington Regional Psychiatric Clinic
Practice address
3215 N Northhills Blvd
Washington Regional Psychiatric Clinic
Fayetteville, AR 72703-4424
Phone
(479) 463-2004
Fax
(479) 463-7864
NPI assigned
Apr 22, 2006
Last updated
Sep 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2010

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

Authorized official

Name
Dan Eckels
Title
Vice President and Cfo
Phone
(479) 463-6026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Psychiatry Physician 2084P0805X NU Primary

Addresses

Primary practice location

3215 N Northhills Blvd
Washington Regional Psychiatric Clinic
Fayetteville, AR 72703-4424

Mailing address

12 E Appleby
Clinic Administration
Fayetteville, AR 72703
Phone (479) 463-1704

Other identifiers 1

IdentifierTypeStateIssuer
148784002MedicaidAR

Other names 1

  • Washington Regional Psychiatric Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041019000920 AR Part B Supplier - Clinic/Group Practice 8820995434 Receives reassigned benefits from 7 practitioners
Practice locations: Fayetteville, AR

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Washington Reg Specialty C26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Encompass Health Rehabilitation Hospital, a Partner of Washington RegiFayetteville, AR, CCN 043032 Hospital 5% Or Greater Indirect Ownership Interest (50%) Dec 31, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 100

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.

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1145664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284940800000",
    "number": "1366408973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY",
            "address_2": "CLINIC ADMINISTRATION",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-463-1704",
            "fax_number": "479-463-7864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3215 N NORTHHILLS BLVD",
            "address_2": "WASHINGTON REGIONAL PSYCHIATRIC CLINIC",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034424",
            "telephone_number": "479-463-2004",
            "fax_number": "479-463-7864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-22",
        "last_updated": "2010-09-20",
        "status": "A",
        "authorized_official_last_name": "ECKELS",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "479-463-6026"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "148784002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washington Regional Psychiatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.