NPIMap

Organization Active NPI

Optimal Pain and Wellness

  • Physical Medicine & Rehabilitation Physician
  • Fayetteville, AR
National Provider Identifier
1487920146
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
E4490 Issued in AR
Legal business name
OPTIMAL PAIN AND WELLNESS
Practice address
1708 E Joyce Blvd
Fayetteville, AR 72703-5252
Phone
(479) 301-2565
Fax
(479) 301-2717
NPI assigned
Mar 28, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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

Authorized official

Name
Dr. Regina E Thurman, MDNPI 1689682353
Title
President
Phone
(479) 301-2565

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
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X E4490 AR Primary

Addresses

Primary practice location

1708 E Joyce Blvd
Fayetteville, AR 72703-5252

Mailing address

1708 E Joyce Blvd
Fayetteville, AR 72703-5252
Phone (479) 301-2565

Other identifiers 1

IdentifierTypeStateIssuer
192058002MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120427000115 AR Part B Supplier - Clinic/Group Practice 8325200942 Receives reassigned benefits from 9 practitioners
Practice locations: Bentonville, AR; Fayetteville, AR; Van Buren, AR
O20130116000191 AR DME Supplier - Physician - Physical and Rehabilitation 8325200942 Practice locations: Fayetteville, AR

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Optimal Pain and Wellness4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1708 E Joyce Blvd
Fayetteville, AR 72703
Phone (479) 301-2565

2925 Alma Hwy
Van Buren, AR 72956

2925 Alma Hwy
Ste C2
Van Buren, AR 72956
Phone (479) 208-1174

2925 Alma Hwy
Ste C1
Van Buren, AR 72956
Phone (479) 301-2565

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1487920146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708 E JOYCE BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035252",
            "telephone_number": "479-301-2565",
            "fax_number": "479-301-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 E JOYCE BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035252",
            "telephone_number": "479-301-2565",
            "fax_number": "479-301-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL PAIN AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-28",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "THURMAN",
        "authorized_official_first_name": "REGINA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-301-2565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AR",
            "license": "E4490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192058002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.