NPIMap

Organization Active NPI

Washington Regional Medical System

Doing business as Washington Regional Family Clinic - East Springdale

  • Family Medicine Physician
  • Springdale, AR
National Provider Identifier
1538423587
Registry record updated Jun 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WASHINGTON REGIONAL MEDICAL SYSTEM
Doing business as
Washington Regional Family Clinic - East Springdale
Practice address
1607 S Old Missouri Rd
Springdale, AR 72764-5723
Phone
(479) 463-4887
Fax
(479) 463-4886
NPI assigned
Jun 25, 2012
Last updated
Jun 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2012

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

Authorized official

Name
Mr. William L Bradley
Title
Ceo
Phone
(479) 463-6300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1607 S Old Missouri Rd
Springdale, AR 72764-5723

Mailing address

1607 S Old Missouri Rd
Springdale, AR 72764-5723
Phone (479) 463-4887

Other names 1

  • Washington Regional Family Clinic - East Springdale Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100130000001 AR Part B Supplier - Clinic/Group Practice 8820995434 Receives reassigned benefits from 117 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springdale, AR; Fayetteville, AR; Harrison, AR; Lincoln, AR; Lowell, AR; Siloam Springs, AR; Berryville, AR; Bentonville, AZ…

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

National Provider Directory

National Provider Directory

Locations

3215 N Northhills Blvd
Ste B150
Fayetteville, AR 72703
Phone (479) 463-2935

1607 S Old Missouri Rd
Springdale, AR 72764
Phone (479) 306-4480

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340582400000",
    "number": "1538423587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 S OLD MISSOURI RD",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727645723",
            "telephone_number": "479-463-4887",
            "fax_number": "479-463-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 S OLD MISSOURI RD",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727645723",
            "telephone_number": "479-463-4887",
            "fax_number": "479-463-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-25",
        "last_updated": "2012-06-25",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-463-6300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washington Regional Family Clinic - East Springdale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springdale, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.