Individual provider Active NPI

Eumar T Tagupa, M.D.

  • Cardiovascular Disease Physician
  • Jonesboro, AR
National Provider Identifier
1497717128
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
E-0880 Issued in AR
Practice address
4802 E Johnson Ave
Jonesboro, AR 72401-8413
Phone
(870) 936-8000
Fax
(870) 934-3630
NPI assigned
Apr 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X E-0880 AR Primary

Addresses

Primary practice location

4802 E Johnson Ave
Jonesboro, AR 72401-8413

Mailing address

PO Box 1960
Jonesboro, AR 72403-1960
Phone (870) 936-8000

Other identifiers 1

IdentifierTypeStateIssuer
129980001MedicaidAR

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040325001288 AR Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4789576703 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St Bernards Hospital Inc. CurrentSince Aug 1, 1996 Accepting new patients
St Bernards Hospital Inc CurrentSince Aug 1, 1996 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Current Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Feb 1, 2010 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Feb 1, 2010 Accepting new patients
Northeast Arkansas Clinic, PA Past Accepting new patients
Northeast Arkansas Health System LLC Cardiovascular Disease Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

909 Enterprise Dr
Jonesboro, AR 72401
Phone (870) 336-1100

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

225 E Washington Ave
Jonesboro, AR 72401
Phone (870) 207-1630

311 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 935-4150

4802 E Johnson Ave
Jonesboro, AR 72405
Phone (901) 227-9820

3024 Stadium Blvd
Jonesboro, AR 72404
Phone (870) 972-7000

1111 Windover Rd
Jonesboro, AR 72401
Phone (870) 935-5432

Interoperability endpoints

  • Direct secure messaging: etagupa29393@direct.bmhcc.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458691200000",
    "number": "1497717128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1960",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031960",
            "telephone_number": "870-936-8000",
            "fax_number": "870-934-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 E JOHNSON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724018413",
            "telephone_number": "870-936-8000",
            "fax_number": "870-934-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAGUPA",
        "first_name": "EUMAR",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2016-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AR",
            "license": "E-0880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129980001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.