NPIMap

Organization Active NPI

Mercy Health Northwest Arkansas Communities

  • Family Medicine Physician
  • Bentonville, AR
National Provider Identifier
1447699434
Registry record updated Apr 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
Practice address
701 SW Regional Airport Blvd
Bentonville, AR 72716-0001
Phone
(479) 268-7640
Fax
(479) 254-2951
NPI assigned
Jun 23, 2013
Last updated
Apr 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2018

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

Authorized official

Name
Benny J Stover
Title
Vice President-Finance
Phone
(479) 338-2230

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X AR

Addresses

Primary practice location

701 SW Regional Airport Blvd
Bentonville, AR 72716-0001

Mailing address

701 SW Regional Airport Blvd
Bentonville, AR 72716-0001
Phone (479) 268-7640

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031216000788 AR Part B Supplier - Clinic/Group Practice 0648177873 Receives reassigned benefits from 485 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rogers, AR; Springdale, AR; Tontitown, AR; Bentonville, AR; Berryville, AR; Centerton, AR; Eureka Springs, AR; Green Forest, AR…

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

515 Enterprise Dr
Ste 300
Lowell, AR 72745
Phone (479) 717-7626

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1371945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522713600000",
    "number": "1447699434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 SW REGIONAL AIRPORT BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160001",
            "telephone_number": "479-268-7640",
            "fax_number": "479-254-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SW REGIONAL AIRPORT BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160001",
            "telephone_number": "479-268-7640",
            "fax_number": "479-254-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-23",
        "last_updated": "2018-04-03",
        "status": "A",
        "authorized_official_last_name": "STOVER",
        "authorized_official_first_name": "BENNY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT-FINANCE",
        "authorized_official_telephone_number": "479-338-2230"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2018; 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.