NPIMap

Individual provider Active NPI

Nicholas L Gentry, MD

  • Emergency Medicine Physician
  • Fayetteville, AR
National Provider Identifier
1497953079
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
E-9119 Issued in AR
Practice address
1438 E Augustine LN Ste 2
Fayetteville, AR 72703-5462
Phone
(479) 335-5777
NPI assigned
Jul 5, 2007
Last updated
Feb 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0101245142 VA
Emergency Medicine Physician 207P00000X E-9119 AR Primary

Addresses

Primary practice location

1438 E Augustine LN Ste 2
Fayetteville, AR 72703-5462

Mailing address

1438 E Augustine LN Ste 2
Fayetteville, AR 72703-5462
Phone (479) 335-5777

Other practice location 1

1420 E Augustine Ln Ste 7
Fayetteville, AR 72703-4995
Phone (479) 305-8206

Other identifiers 1

IdentifierTypeStateIssuer
12518279OtherCAQH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150605002522 AR Practitioner - Emergency Medicine 8123152824 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-9119ARMDEmergency Medicine Physician
0101245142VAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System CurrentSince May 1, 2015 Accepting new patients
Washington Regional Medical System CurrentSince May 1, 2015 Accepting new patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Dec 1, 2017 Accepting new patients
Washington Regional Medical System Current Accepting new patients
Washington Regional Medical Center Past Accepting new patients
Blue & Grey Emergency Physicians LLC Emergency Medicine Past Accepting new patients
VA-I Medical Services PC Past Accepting new patients
Washington Regional Medical System Past Accepting new patients
Washington Regional Medical System Past Accepting new patients
Ehra Medical Services of Virginia, PC Emergency Medicine Past Accepting new patients
Piedmont Emergency Consultants, PLC Emergency Medicine Past Accepting new patients
Martha Jefferson Hospital Past Accepting new patients
Tuckahoe Creek Emergency Physicians LLC Emergency Medicine Past Accepting new patients

Locations

3215 N Northhills Blvd
Fayetteville, AR 72703
Phone (479) 463-1000

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

Organizations & group practices 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1497953079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1438 E AUGUSTINE LN STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035462",
            "telephone_number": "479-335-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1438 E AUGUSTINE LN STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035462",
            "telephone_number": "479-335-5777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1420 E Augustine Ln Ste 7",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727034995",
            "country_code": "US",
            "telephone_number": "479-305-8206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GENTRY",
        "first_name": "NICHOLAS",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-05",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101245142",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E-9119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12518279",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.