Executive Park Surgery Center of Fort Smith, Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

APPLIED FOR Issued in AR

Legal business name

EXECUTIVE PARK SURGERY CENTER OF FORT SMITH, INC

Practice address

3314 S 70TH St
Fort Smith, AR 72903-5052

Phone

(479) 424-2744

Fax

(479) 424-2745

NPI assigned

Dec 16, 2010

Organization subpart

No

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

Authorized official

Name

Christopher J Rodriguez, M.D.NPI 1942573639

Title

President

Phone

(479) 424-2744

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Listed as

Executive Park Surgery Center of Fort Smith IncCCN 04C0001059

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Joel Rodriguez, MD

  • Ophthalmology Physician
  • Fort Smith, AR
  • NPI 1942573639
  NPD Authorized official

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

{
    "created_epoch": "1292457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1598068306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3314 S 70TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035052",
            "telephone_number": "479-424-2744",
            "fax_number": "479-424-2745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3314 S 70TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035052",
            "telephone_number": "479-424-2744",
            "fax_number": "479-424-2745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE PARK SURGERY CENTER OF FORT SMITH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-16",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-424-2744",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AR",
            "license": "APPLIED FOR",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Evans
• Ashton Evans
• Julie Lynn Evans, LPN
• Dyanne Everett-Cantrell, MHPP
• Stephanie Lynn Everitt-Smith, PHD, PT
• Executive Park Surgery Center, LLC
• Eye Group, LLC
• Eye Group, LLC
• Eye Group, LLC
• Eye Group, LLC

• Ambulatory Surgical Clinic/Center in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Ambulatory Surgical Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.