NPIMap

Individual provider Active NPI

Thomas Kirk Rogerson, P.T.

  • Physical Therapist
  • Fayetteville, AR
National Provider Identifier
1497728000
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT937 Issued in AR
Practice address
3561 Johnson Mill Blvd Ste 201
Fayetteville, AR 72704-5065
Phone
(479) 404-4530
Fax
(479) 404-4526
NPI assigned
Feb 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT937 AR Primary

Addresses

Primary practice location

3561 Johnson Mill Blvd Ste 201
Fayetteville, AR 72704-5065

Mailing address

3561 Johnson Mill Blvd Ste 201
Fayetteville, AR 72704-5065
Phone (479) 404-4530

Other identifiers 2

IdentifierTypeStateIssuer
710685433OtherARTAX ID
5S355OtherARBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040924000848 AR Practitioner - Physical Therapist in Private Practice 8022087238 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington Regional Medical SystemGroup PAC ID 8820995434, 238 clinicians

Practice addresses (Care Compare)

3561 Johnson Mill Blvd
Fayetteville, AR 72704-5065

813 Founders Park Dr E
Suite 101
Springdale, AR 72762-6321
Phone (479) 463-2333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System CurrentSince Sep 1, 2016 Accepting new patients
Washington Regional Medical System CurrentSince Jul 1, 2020 Accepting new patients
Washington Regional Medical System Current Accepting new patients
Washington Regional Medical System CurrentSince Sep 1, 2016 Accepting new patients
Washington Regional Medical System PastSince Jun 27, 2021 Accepting new patients
Ozark Orthopaedics, P.a. Past Accepting new patients

Locations

3336 N Futrall Dr
Fayetteville, AR 72703
Phone (479) 444-8827

114 E Sunbridge Dr
#J
Fayetteville, AR 72703
Phone (479) 463-2597

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1497728000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3561 JOHNSON MILL BLVD STE 201",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727045065",
            "telephone_number": "479-404-4530",
            "fax_number": "479-404-4526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3561 JOHNSON MILL BLVD STE 201",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727045065",
            "telephone_number": "479-404-4530",
            "fax_number": "479-404-4526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERSON",
        "first_name": "THOMAS",
        "middle_name": "KIRK",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "710685433",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5S355",
            "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 Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.