NPIMap

Organization Active NPI

Bohannan Irgens Group LLC

  • Physical Therapy Clinic/Center
  • Greenwood, AR
National Provider Identifier
1417313925
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT2764 Issued in AR
Legal business name
BOHANNAN IRGENS GROUP LLC
Practice address
515 Forrest Park Way
Greenwood, AR 72936-5955
Phone
(479) 597-8318
NPI assigned
Jan 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

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

Authorized official

Name
Dr. David Bohannan, PT, DPTNPI 1306942198
Title
Owner
Phone
(479) 597-8318

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT2764 AR Primary

Addresses

Primary practice location

515 Forrest Park Way
Greenwood, AR 72936-5955

Mailing address

515 Forrest Park Way
Greenwood, AR 72936-5955

Other practice location 1

11735 Old Highway 71 Ste 101
Fort Smith, AR 72916-7023
Phone (479) 434-4033

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160525002947 AR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2365732757 Receives reassigned benefits from 3 practitioners
Practice locations: Greenwood, AR

National Provider Directory

National Provider Directory

Locations

11735 Old Highway 71
Ste 101
Fort Smith, AR 72916
Phone (479) 434-4033

618 W Center St
Greenwood, AR 72936
Phone (479) 996-2525

515 Forrest Park Way
Greenwood, AR 72936
Phone (479) 597-8318

Practitioners & affiliated clinicians

Practitioners 11

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": "1452643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1417313925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 FORREST PARK WAY",
            "city": "GREENWOOD",
            "state": "AR",
            "postal_code": "729365955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 FORREST PARK WAY",
            "city": "GREENWOOD",
            "state": "AR",
            "postal_code": "729365955",
            "telephone_number": "479-597-8318"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11735 Old Highway 71 Ste 101",
            "address_purpose": "LOCATION",
            "city": "Fort Smith",
            "state": "AR",
            "postal_code": "729167023",
            "country_code": "US",
            "telephone_number": "479-434-4033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BOHANNAN IRGENS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-13",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "BOHANNAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-597-8318",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AR",
            "license": "PT2764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; 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.