Individual provider Active NPI

Jason H Wardell, PA

  • Physician Assistant
  • Little Rock, AR
National Provider Identifier
1396709150
Registry record updated Feb 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA235 Issued in AR
Practice address
10301 Kanis Rd
Little Rock, AR 72205-6205
Phone
(501) 604-6900
Fax
(501) 604-6941
NPI assigned
Apr 17, 2006
Last updated
Feb 3, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA235 AR Primary
Medical Physician Assistant 363AM0700X PA235 AR
Surgical Physician Assistant 363AS0400X PA235 AR

Addresses

Primary practice location

10301 Kanis Rd
Little Rock, AR 72205-6205

Mailing address

10301 Kanis Rd
Little Rock, AR 72205-6205
Phone (501) 604-6900

Other identifiers 1

IdentifierTypeStateIssuer
204192795MedicaidAR

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090709000032 AR Practitioner - Physician Assistant 4688724149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Practice addresses (Care Compare)

9500 Baptist Health Dr
Suite 210
Little Rock, AR 72205-6319
Phone (501) 217-3533

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA235ARMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Health Group CurrentSince Sep 3, 2018 Accepting new patients
Arkansas Health Group CurrentSince Sep 3, 2018 Accepting new patients

Locations

11001 Executive Center Dr
Ste 200
Little Rock, AR 72211
Phone (501) 812-7215

9500 Baptist Health Dr
Ste 210
Little Rock, AR 72205
Phone (501) 217-3533

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 1

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": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422921600000",
    "number": "1396709150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10301 KANIS RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056205",
            "telephone_number": "501-604-6900",
            "fax_number": "501-604-6941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10301 KANIS RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056205",
            "telephone_number": "501-604-6900",
            "fax_number": "501-604-6941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARDELL",
        "first_name": "JASON",
        "middle_name": "H",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2015-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA235",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PA235",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AR",
            "license": "PA235",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204192795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.