Jose Albert Ang Fontanilla Jr., MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

E3107 Issued in AR

Practice address

4077 Elm Springs Rd Ste 105
Springdale, AR 72762-3703

Phone

(479) 927-2100

Fax

(479) 927-2211

NPI assigned

Apr 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jose.fontanilla.3@2229.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwest Benton County Physician Services LLC

  • Family Medicine Physician
  • Bentonville, AR
  • NPI 1871553073

  AR

  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  AR

  Medicare reassignment NPD
• Circle of Life

  • Community Based Hospice Care Agency
  • Springdale, AR
  • NPI 1386755460
  NPD
• Mercy Health Northwest Arkansas Communities

  • Multi-Specialty Clinic/Center
  • Rogers, AR
  • NPI 1265490916
  NPD (past)

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1497712640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 N THOMPSON SUITE A",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "72764",
            "telephone_number": "479-750-6566",
            "fax_number": "479-750-5251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 ELM SPRINGS RD STE 105",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727623703",
            "telephone_number": "479-927-2100",
            "fax_number": "479-927-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTANILLA",
        "first_name": "JOSE",
        "middle_name": "ALBERT ANG",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "AR",
            "license": "E3107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146213001",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jose.fontanilla.3@2229.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "4077 Elm Springs Rd Ste 105",
            "city": "Springdale",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727623703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tina D Flowers
• Delinda S Floyd, MPT
• Dennis N Floyd, MD
• Colinda N Fogg
• Machen Beard Fogleman, SLP
• Shanovia Forbes
• Charity Nicole Ford, LMT
• Craig D Ford, MHPP
• Caitlin Forrest
• John M Forrest, PHARMD

• All providers in Springdale, AR
• Geriatric Medicine (Internal Medicine) Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.