Individual provider Active NPI

Eduardo A Demondesert, MD

  • Gastroenterology Physician
  • Fort Smith, AR
National Provider Identifier
1386675536
Registry record updated Aug 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
E-0435 Issued in AR
Practice address
6801 Rogers Ave
Fort Smith, AR 72903-4067
Phone
(479) 274-3200
Fax
(479) 274-3289
NPI assigned
Jul 6, 2006
Last updated
Aug 28, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X E-0435 AR Primary

Addresses

Primary practice location

6801 Rogers Ave
Fort Smith, AR 72903-4067

Mailing address

PO Box 3528
Fort Smith, AR 72913-3528
Phone (479) 274-2000

Other identifiers 2

IdentifierTypeStateIssuer
127259001MedicaidAR
110151252OtherRR MEDICARE

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
I20050726000735 AR Practitioner - Gastroenterology 6103853635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6801 Rogers Ave
Fort Smith, AR 72903-4067
Phone (479) 274-4100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy227
Upper gastrointestinal (GI) endoscopy for acid reflux393

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-0435ARMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Fort Smith Communities CurrentSince Nov 1, 2017 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Nov 1, 2017 Accepting new patients

Locations

6801 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-6000

6801 Rogers Ave
Fl 2
Fort Smith, AR 72903
Phone (479) 274-2800

7001 Rogers Ave
Fort Smith, AR 72903
Phone (479) 478-3510

7001 Rogers Ave
Ste 200
Fort Smith, AR 72903
Phone (479) 314-4620

7306 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-2804

Interoperability endpoints

  • Direct secure messaging: edemondesert133900@directc.mercy.net

Organizations & group practices 2

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 3

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440720000000",
    "number": "1386675536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3528",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729133528",
            "telephone_number": "479-274-2000",
            "fax_number": "479-274-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729034067",
            "telephone_number": "479-274-3200",
            "fax_number": "479-274-3289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMONDESERT",
        "first_name": "EDUARDO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2015-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": "E-0435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127259001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110151252",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.