Active NPI
Annette M Enderlin, M.D.
- Ophthalmology Physician
- Benton, AR
National Provider Identifier
1457325417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- C7476
- Practice address
- 3 Medical Park Dr
Suite 300
Benton, AR 72015-3728 - Phone
- (501) 778-1113
- Fax
- (501) 778-5391
- NPI assigned
- Feb 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | C7476 | AR | Primary |
Addresses
Primary practice location
3 Medical Park Dr
Suite 300
Benton, AR 72015-3728
Mailing address
3 Medical Park Dr Ste 300
Benton, AR 72015-3726
Phone (501) 778-1113
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6891055002 | Other | AR | CIGNA |
| 0820031 | Other | AR | UNITEDHEALTHCARE |
| 13767000000 | Other | AR | QUALCHOICE |
| 180034661 | Other | AR | RAILROAD MEDICARE |
| 122419001 | Medicaid | AR | |
| 4570317 | Other | AR | AETNA |
| 71081368572015A002 | Other | AR | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C7476 | AR | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380499200000",
"number": "1457325417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 MEDICAL PARK DR STE 300",
"city": "BENTON",
"state": "AR",
"postal_code": "720153726",
"telephone_number": "501-778-1113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 MEDICAL PARK DR",
"address_2": "SUITE 300",
"city": "BENTON",
"state": "AR",
"postal_code": "720153728",
"telephone_number": "501-778-1113",
"fax_number": "501-778-5391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENDERLIN",
"first_name": "ANNETTE",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-15",
"last_updated": "2013-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "AR",
"license": "C7476",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "6891055002",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITEDHEALTHCARE",
"identifier": "0820031",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALCHOICE",
"identifier": "13767000000",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "180034661",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "122419001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4570317",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "71081368572015A002",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Benton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.