Individual provider Active NPI

Mary Frances Daut, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Fayetteville, AR
National Provider Identifier
1366471211
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
E3954 Issued in AR
Practice address
1708 E Joyce Blvd
Ste 3
Fayetteville, AR 72703-5252
Phone
(479) 301-2565
Fax
(479) 301-2717
NPI assigned
Jul 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X E3954 AR Primary

Addresses

Primary practice location

1708 E Joyce Blvd
Ste 3
Fayetteville, AR 72703-5252

Mailing address

1708 E Joyce Blvd Ste 3
Fayetteville, AR 72703-5251
Phone (479) 464-5829

Other identifiers 1

IdentifierTypeStateIssuer
156621001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050608001167 AR Practitioner - Physical Medicine and Rehabilitation 2163471764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
University of Arkansas College of Medicine, 2000
Medicare assignment
May accept Medicare assignment
Group practices
Optimal Pain and WellnessGroup PAC ID 8325200942, 4 clinicians

Practice addresses (Care Compare)

909 SE 28TH St
Suite 5
Bentonville, AR 72712-3211
Phone (479) 301-2565

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E3954ARMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optimal Pain and Wellness CurrentSince Sep 1, 2013 Accepting new patients
Optimal Pain and Wellness Pain Medicine CurrentSince Sep 1, 2013 Accepting new patients
D. Wayne Brooks, M.D., P.a. PastSince Sep 2, 2013 Accepting new patients

Locations

909 SE 28th St
Ste 5
Bentonville, AR 72712
Phone (479) 273-3376

1708 E Joyce Blvd
Ste 3
Fayetteville, AR 72703
Phone (479) 301-2565

Interoperability endpoints

  • Direct secure messaging: maryfrances.daut@4085.securemail.prognocis.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402358400000",
    "number": "1366471211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708 E JOYCE BLVD STE 3",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035251",
            "telephone_number": "479-464-5829",
            "fax_number": "479-725-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 E JOYCE BLVD",
            "address_2": "STE 3",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035252",
            "telephone_number": "479-301-2565",
            "fax_number": "479-301-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUT",
        "first_name": "MARY FRANCES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-02",
        "last_updated": "2014-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "AR",
            "license": "E3954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156621001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.