Washington Regional Medicorp, Inc.

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

WASHINGTON REGIONAL MEDICORP, INC.

Doing business as

PACE of the Ozarks

Practice address

813 Founders Park Dr E Ste 107
Springdale, AR 72762-6314

Phone

(479) 463-6600

Fax

(479) 463-6601

NPI assigned

Jul 26, 2018

Last updated

Jun 6, 2024By 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

Mr. Jack Morris

Title

Ceo

Phone

(479) 463-6600

Specialties & licenses 1

Addresses

Other names 1

• PACE of the Ozarks Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Noelle J Andrychowicz, APRN, CNP

  • Nurse Practitioner
  • Springdale, AR
  • NPI 1629341250
  NPD (past)
• Kyla Kristine Grant, DNP

  • Gerontology Nurse Practitioner
  • Fort Smith, AR
  • NPI 1982276150
  NPD (past)
• Fredrick Allan Martin, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Springdale, AR
  • NPI 1407815467
  NPD (past)

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717632000000",
    "number": "1366929846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 FOUNDERS PARK DR E STE 107",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626314",
            "telephone_number": "479-463-6600",
            "fax_number": "479-463-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 FOUNDERS PARK DR E STE 107",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626314",
            "telephone_number": "479-463-6600",
            "fax_number": "479-463-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICORP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-26",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-463-6600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PACE of the Ozarks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Washington Regional Medical System (Shiloh Clinic Washington Regional)
• Washington Regional Medical System (Washington Regional Family Clinic - Springdale)
• Washington Regional Medical System (Washington Regional Family Clinic - East Springdale)
• Washington Regional Medical System (Renal Specialists of Northwest Arkansas)
• Washington Regional Medical System (Harber Internal Medicine - Washington Regional)
• Lisa Renee Waterman, D.O.
• Watermark Chiropractic
• Waterstone Counseling Center PLLC
• Carly Watkins, COTA/L
• Laura Watkins

• PACE Provider Organization in Springdale, AR
• Providers in Springdale, AR by specialty
• PACE Provider Organization in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.