Individual provider Active NPI

Lee Walter Thomas, PA-C

  • Physician Assistant
  • Bentonville, AR
National Provider Identifier
1508099367
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
901 SE Plaza Ave Ste 5
Bentonville, AR 72712-5473
Phone
(479) 273-3376
Fax
(479) 273-3468
NPI assigned
Aug 27, 2009
Last updated
Sep 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

901 SE Plaza Ave Ste 5
Bentonville, AR 72712-5473

Mailing address

901 SE Plaza Ave Ste 5
Bentonville, AR 72712-5473
Phone (479) 273-3376

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, LA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091027000552 AR Practitioner - Physician Assistant 7517004369
I20110816000351 LA Practitioner - Physician Assistant 7517004369 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
81.51 of 100Reported as apm
Quality
60.04
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Clinic of Monroe CurrentSince Jul 27, 2011 Accepting new patients
Affinity Health Group, LLC CurrentSince Oct 3, 2016 Accepting new patients
Affinity Health Group, LLC CurrentSince Oct 3, 2016 Accepting new patients
Premier Dermatology & Skin Renewal Center Past Accepting new patients

Locations

130 Desiard St
Ste 355
Monroe, LA 71201
Phone (318) 807-7875

1501 Louisville Ave
Monroe, LA 71201
Phone 31832384514310

2408 Broadmoor Blvd
Ste 2
Monroe, LA 71201
Phone (318) 807-0525

2516 Broadmoor Blvd
Monroe, LA 71201
Phone (318) 322-1161

707 S Vienna St
Ruston, LA 71270
Phone (318) 224-3044

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1508099367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 SE PLAZA AVE STE 5",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727125473",
            "telephone_number": "479-273-3376",
            "fax_number": "479-273-3468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 SE PLAZA AVE STE 5",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727125473",
            "telephone_number": "479-273-3376",
            "fax_number": "479-273-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "LEE",
        "middle_name": "WALTER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-27",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.