NPIMap

Organization Active NPI

Pinnacle Anesthesia Group, PLLC

  • Anesthesiology Physician
  • Rogers, AR
National Provider Identifier
1487358941
Registry record updated Mar 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
PINNACLE ANESTHESIA GROUP, PLLC
Practice address
3721 S Champions Dr
Rogers, AR 72758-8713
Phone
(936) 870-6125
NPI assigned
Mar 29, 2023
Last updated
Mar 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2023

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

Authorized official

Name
Mr. Justin Slade Bridwell, CRNANPI 1407814924
Title
President/Ceo
Phone
(479) 426-6744

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
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

3721 S Champions Dr
Rogers, AR 72758-8713

Mailing address

4452 W Hidden Acres CT
Rogers, AR 72758-6010
Phone (479) 426-6744

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231013001074 AR Part B Supplier - Clinic/Group Practice 9537514385 Receives reassigned benefits from 18 practitioners
Practice locations: Fayetteville, AR; Rogers, AR

National Provider Directory

National Provider Directory

Locations

3721 S Champions Dr
Ste 100
Rogers, AR 72758
Phone (479) 336-5150

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1680048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680048000000",
    "number": "1487358941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4452 W HIDDEN ACRES CT",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727586010",
            "telephone_number": "479-426-6744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3721 S CHAMPIONS DR",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588713",
            "telephone_number": "936-870-6125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE ANESTHESIA GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-29",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A",
        "authorized_official_last_name": "BRIDWELL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "SLADE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "479-426-6744",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.