NPIMap

Individual provider Active NPI

Brandon S Chism, M.D.

  • Cardiovascular Disease Physician
  • Fayetteville, AR
National Provider Identifier
1376500108
Registry record updated Jun 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
E-4651 Issued in AR
Practice address
3211 N Northhills Blvd
Suite 110
Fayetteville, AR 72703-4007
Phone
(479) 571-4338
Fax
(479) 571-4015
NPI assigned
Apr 26, 2006
Last updated
Jun 28, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 35183 AZ
Cardiovascular Disease Physician 207RC0000X E-4651 AR Primary

Addresses

Primary practice location

3211 N Northhills Blvd
Suite 110
Fayetteville, AR 72703-4007

Mailing address

3211 N Northhills Blvd
Suite 110
Fayetteville, AR 72703-4007
Phone (479) 571-4338

Other identifiers 3

IdentifierTypeStateIssuer
P00381947OtherAZRAILROAD MEDICARE
090498MedicaidAZ
E-4651OtherARSTATE MEDICAL LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100917000918 AR Practitioner - Cardiovascular Disease (Cardiology) 1557373412 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Arkansas College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington Regional Medical SystemGroup PAC ID 8820995434, shared by 13 NPIs, 238 clinicians

Practice addresses (Care Compare)

3215 N Northhills Blvd
Washington Regional Hospital Medicine Group
Fayetteville, AR 72703-4424
Phone (479) 463-7102

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting81
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-4651ARMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System CurrentSince Jul 28, 2010 Accepting new patients
Washington Regional Medical System CurrentSince Jun 1, 2019 Accepting new patients
Washington Regional Medical System Current Accepting new patients
Washington Regional Medical System CurrentSince Jul 28, 2010 Accepting new patients
Washington Regional Medical Center Past Accepting new patients

Locations

12 E Appleby Rd
Ste 102
Fayetteville, AR 72703
Phone (479) 463-4746

3211 N Northhills Blvd
Ste 110
Fayetteville, AR 72703
Phone (479) 571-4338

3215 N Northhills Blvd
Fayetteville, AR 72703
Phone (479) 463-1000

Interoperability endpoints

  • Direct secure messaging: bchism21344@washingtonregional.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1376500108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3211 N NORTHHILLS BLVD",
            "address_2": "SUITE 110",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034007",
            "telephone_number": "479-571-4338",
            "fax_number": "479-571-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3211 N NORTHHILLS BLVD",
            "address_2": "SUITE 110",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034007",
            "telephone_number": "479-571-4338",
            "fax_number": "479-571-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISM",
        "first_name": "BRANDON",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "35183",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AR",
            "license": "E-4651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00381947",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090498",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "E-4651",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.