NPIMap

Organization Active NPI

Medical Associates of Northwest Arkansas PA

  • Family Medicine Physician
  • Fayetteville, AR
National Provider Identifier
1407806052
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA
Practice address
2523 E Huntsville Rd
Fayetteville, AR 72701-7329
Phone
(479) 442-2822
Fax
(479) 582-1754
NPI assigned
May 12, 2006
Last updated
Dec 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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

Authorized official

Name
Terry Hurt
Title
Cfo
Phone
(479) 571-6780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2523 E Huntsville Rd
Fayetteville, AR 72701-7329

Mailing address

PO Box 1523
Fayetteville, AR 72702-1523
Phone (479) 571-6038

Other identifiers 2

IdentifierTypeStateIssuer
5B809OtherARAR BLUE CROSS/BLUE SHIELD
155662002MedicaidAR

Other names 1

  • MANA FM South Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041001000671 AR Part B Supplier - Clinic/Group Practice 3678542073 Receives reassigned benefits from 130 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bentonville, AR; Springdale, AR; Rogers, AR; Prairie Grove, AR; Lowell, AR; Harrison, AR; Fayetteville, AR; Bella Vista, AR

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765756800000",
    "number": "1407806052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1523",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727021523",
            "telephone_number": "479-571-6038",
            "fax_number": "479-582-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2523 E HUNTSVILLE RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727017329",
            "telephone_number": "479-442-2822",
            "fax_number": "479-582-1754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A",
        "authorized_official_last_name": "HURT",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "479-571-6780"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BLUE CROSS/BLUE SHIELD",
            "identifier": "5B809",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155662002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MANA FM South",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.