NPIMap

Individual provider Active NPI

Michael Lowell Moulton, MD

  • Nephrology Physician
  • Springdale, AR
National Provider Identifier
1558397489
Registry record updated Nov 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
E-4391 Issued in AR
Practice address
813 Founders Park Dr E
Springdale, AR 72762-6314
Phone
(479) 463-2440
Fax
(479) 463-2465
NPI assigned
Jun 23, 2006
Last updated
Nov 6, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X E-4391 AR Primary

Addresses

Primary practice location

813 Founders Park Dr E
Springdale, AR 72762-6314

Mailing address

PO Box 550
Lowell, AR 72745-0550
Phone (479) 463-7775

Other identifiers 4

IdentifierTypeStateIssuer
5N139OtherARAR BC/BS
200054700AMedicaidOK
156776001MedicaidAR
P00219962OtherARRR MCR

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
I20050512000964 AR Practitioner - NephrologyPractitioner - Internal Medicine 6709842107 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

107 E Monte Painter Dr
Renal Specialists of Northwest Arkasas
Fayetteville, AR 72703-4002
Phone (479) 463-7000

2125 E Main St
12 Renal Specialists of Northwest Arkansas
Siloam Springs, AR 72761-5576
Phone (479) 524-5214

3 E Appleby Rd
Suite 101
Fayetteville, AR 72703-3156
Phone (479) 463-7400

3000 NW a St
Renal Specialists of Northwest Arkansas
Bentonville, AR 72712-3985
Phone (479) 268-3050

813 Founders Park Dr E
202 Harber Internal Medicine Washington
Springdale, AR 72762-6322
Phone (479) 463-3090

813 Founders Park Dr E
203 Renal Specialists of Northwest Arkansas
Springdale, AR 72762-6314
Phone (479) 463-2440

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

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ozark Senior Healthcare, PLLC CurrentSince May 1, 2015 Accepting new patients
Washington Regional Medical System CurrentSince Jun 1, 2013 Accepting new patients
Washington Regional Medical System Current Accepting new patients
Washington Regional Medical System CurrentSince Jun 1, 2013 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Dec 19, 2018 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Dec 19, 2018 Accepting new patients

Locations

1125 N College Ave
Fayetteville, AR 72703
Phone (479) 521-8260

3344 N Futrall Dr
Fayetteville, AR 72703
Phone (479) 582-7213

6801 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-6000

7001 Rogers Ave
Ste 200
Fort Smith, AR 72903
Phone (479) 314-4620

210 S Thompson St
Ste 4A
Springdale, AR 72764
Phone (479) 445-9900

Interoperability endpoints

  • Direct secure messaging: michaelmoulton@wrms.allscriptsdirect.net
  • Direct secure messaging: mmoulton36137@washingtonregional.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383696000000",
    "number": "1558397489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727450550",
            "telephone_number": "479-463-7775",
            "fax_number": "479-463-7187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 FOUNDERS PARK DR E",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626314",
            "telephone_number": "479-463-2440",
            "fax_number": "479-463-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULTON",
        "first_name": "MICHAEL",
        "middle_name": "LOWELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2013-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AR",
            "license": "E-4391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BC/BS",
            "identifier": "5N139",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200054700A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156776001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "P00219962",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springdale, AR

Sources for this page

Verify at the official NPI Registry.