Active NPI
John Brunner III, MD
- Anesthesiology Physician
- Fayetteville, AR
National Provider Identifier
1568446664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- C4438
- Practice address
- 3215 N Northhills Blvd
Fayetteville, AR 72703-4424 - Phone
- (918) 664-9892
- Fax
- (918) 664-2521
- NPI assigned
- Dec 1, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | C4438 | AR | Primary |
Addresses
Primary practice location
3215 N Northhills Blvd
Fayetteville, AR 72703-4424
Mailing address
PO Box 1867
Fayetteville, AR 72702-1867
Phone (918) 664-9892
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104564001 | Medicaid | AR | |
| 100073220A | Medicaid | OK | |
| 770119201 | Other | AR | ARKANSAS BREASTCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozark Regional Anesthesia | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Fayetteville, AR
- NPI 1275517468
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328832000000",
"number": "1568446664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1867",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727021867",
"telephone_number": "918-664-9892",
"fax_number": "918-664-2521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3215 N NORTHHILLS BLVD",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727034424",
"telephone_number": "918-664-9892",
"fax_number": "918-664-2521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNNER",
"first_name": "JOHN",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-01",
"last_updated": "2012-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "AR",
"license": "C4438",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104564001",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100073220A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARKANSAS BREASTCARE",
"identifier": "770119201",
"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 Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.