Individual provider Active NPI

Samuel Tanner Burks, CRNA

  • Certified Registered Nurse Anesthetist
  • Springdale, AR
National Provider Identifier
1407419278
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
121151 Issued in AR
Practice address
609 W Maple Ave
Springdale, AR 72764-5335
Phone
(479) 751-3722
Fax
(479) 751-1099
NPI assigned
Apr 17, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R095402 AR
Certified Registered Nurse Anesthetist 367500000X 121151 AR Primary

Addresses

Primary practice location

609 W Maple Ave
Springdale, AR 72764-5335

Mailing address

601 W Maple Ave Ste 503
Springdale, AR 72764-5376
Phone (479) 751-3722

Other practice location 1

2710 S Rife Medical Ln
Rogers, AR 72758-1452
Phone (479) 338-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190725003267 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 1759617988 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Youngs Professional Services LLCGroup PAC ID 2163524992, 297 clinicians

Practice addresses (Care Compare)

609 W Maple Ave
Springdale, AR 72764-5335
Phone (479) 757-4001

700 W Grove St
Medical Center of South Arkansas
El Dorado, AR 71730-4416
Phone (870) 863-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
R095402ARMDRegistered Nurse
121151ARMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Youngs Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 24, 2025 Accepting new patients
Anesthesia Services of Benton County PA CurrentSince Jan 1, 2022 Accepting new patients
Capital Anesthesia Solutions of Arkansas, LLC Nurse Anesthetist, Certified Registered CurrentSince May 1, 2024 Accepting new patients
Renew Medical Group of Arkansas LTD Nurse Anesthetist, Certified Registered CurrentSince May 1, 2025 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Past Accepting new patients

Locations

3000 Medical Center Pkwy
Bentonville, AR 72712
Phone (479) 553-2524

700 W Grove St
El Dorado, AR 71730
Phone (870) 863-2200

3873 N Parkview Dr
Fayetteville, AR 72703
Phone (479) 527-0050

7301 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-4600

2710 S Rife Medical Ln
Rogers, AR 72758
Phone (479) 338-8000

2708 S Rife Medical Ln
Ste 300
Rogers, AR 72758
Phone (479) 338-3030

603 N Progress Ave
Siloam Springs, AR 72761
Phone (479) 215-3000

609 W Maple Ave
Springdale, AR 72764
Phone (479) 751-5711

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 and National Provider Directory roles.

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": "1555459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1407419278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 W MAPLE AVE STE 503",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727645376",
            "telephone_number": "479-751-3722",
            "fax_number": "479-751-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 W MAPLE AVE",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727645335",
            "telephone_number": "479-751-3722",
            "fax_number": "479-751-1099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2710 S Rife Medical Ln",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727581452",
            "country_code": "US",
            "telephone_number": "479-338-8000",
            "fax_number": "479-338-3056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURKS",
        "first_name": "SAMUEL",
        "middle_name": "TANNER",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-17",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R095402",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "121151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springdale, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.