NPIMap

Organization Active NPI

Nea Reliant Health Care Professionals Inc

Doing business as Bono Family Medical Clinic and Therapy Services

  • Family Nurse Practitioner
  • Bono, AR
National Provider Identifier
1467829804
Registry record updated Dec 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A003947 Issued in AR
Legal business name
NEA RELIANT HEALTH CARE PROFESSIONALS INC
Doing business as
Bono Family Medical Clinic and Therapy Services
Practice address
9146 Highway 63 N
Bono, AR 72416-8153
Phone
(870) 930-9990
Fax
(870) 930-9992
NPI assigned
Sep 1, 2015
Last updated
Dec 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2016

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

Authorized official

Name
Jeremy BergmanNPI 1053625533
Title
Owner
Phone
(870) 930-9990

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
Family Nurse Practitioner 363LF0000X A003947 AR Primary

Addresses

Primary practice location

9146 Highway 63 N
Bono, AR 72416-8153

Mailing address

9146 Highway 63 N
Bono, AR 72416-8153
Phone (870) 930-9990

Other identifiers 2

IdentifierTypeStateIssuer
1083046445OtherARNPI
200136758MedicaidAR

Other names 1

  • BONO FAMILY MEDICAL CLINIC AND THERAPY SERVICES Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151130000972 AR Part B Supplier - Clinic/Group Practice 0244530095 Receives reassigned benefits from 13 practitioners
Practice locations: Bono, AR; Walnut Ridge, AR

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12230/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482883200000",
    "number": "1467829804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9146 HIGHWAY 63 N",
            "city": "BONO",
            "state": "AR",
            "postal_code": "724168153",
            "telephone_number": "870-930-9990",
            "fax_number": "870-930-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9146 HIGHWAY 63 N",
            "city": "BONO",
            "state": "AR",
            "postal_code": "724168153",
            "telephone_number": "870-930-9990",
            "fax_number": "870-930-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEA RELIANT HEALTH CARE PROFESSIONALS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-01",
        "last_updated": "2016-12-28",
        "status": "A",
        "authorized_official_last_name": "BERGMAN",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-930-9990"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A003947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1083046445",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200136758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BONO FAMILY MEDICAL CLINIC AND THERAPY SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bono, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.