Active NPI
Johnson Regional Medical Center Specialty Physicians
- Rheumatology Physician
- Clarksville, AR
National Provider Identifier
1487081469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- E-3265
- Legal business name
- JOHNSON REGIONAL MEDICAL CENTER SPECIALTY PHYSICIANS
- Practice address
- 1000 E Poplar St
Clarksville, AR 72830-4402 - Phone
- (479) 754-5454
- NPI assigned
- Oct 4, 2013
- Organization subpart
- Yes
- Parent organization
- JOHNSON REGIONAL MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- C Edward Anderson
- Title
- Cfo
- Phone
- (479) 754-5454
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | E-3265 | AR | Primary |
Addresses
Primary practice location
1000 E Poplar St
Clarksville, AR 72830-4402
Mailing address
PO Box 738
Clarksville, AR 72830-0738
Phone (479) 754-5454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040623000733 | AR | Part B Supplier - Clinic/Group Practice | 1658360284 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clarksville, AR |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Emergency Medicine Physician
- Clarksville, AR
- NPI 1336198555
O20040623000733
National Provider Directory
National Provider Directory- Part of
- Johnson Regional Med Ctr
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380844800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1380844800000",
"number": "1487081469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 738",
"city": "CLARKSVILLE",
"state": "AR",
"postal_code": "728300738",
"telephone_number": "479-754-5454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 E POPLAR ST",
"city": "CLARKSVILLE",
"state": "AR",
"postal_code": "728304402",
"telephone_number": "479-754-5454"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JOHNSON REGIONAL MEDICAL CENTER SPECIALTY PHYSICIANS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "JOHNSON REGIONAL MEDICAL CENTER",
"enumeration_date": "2013-10-04",
"last_updated": "2013-10-04",
"status": "A",
"authorized_official_last_name": "ANDERSON",
"authorized_official_first_name": "C",
"authorized_official_middle_name": "EDWARD",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "479-754-5454"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Rheumatology",
"state": "AR",
"license": "E-3265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; 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.