Individual provider Active NPI

Clarisse Tallah, M.D.

  • Family Medicine Physician
  • Bentonville, AR
National Provider Identifier
1609225499
Registry record updated Mar 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-19686 Issued in AR
Practice address
201 SW 14TH St
Bentonville, AR 72712-7449
Phone
(479) 785-2229
Fax
(479) 314-3185
NPI assigned
Jun 13, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2021030592 MO
Family Medicine Physician 207Q00000X E-19686 AR Primary

Addresses

Primary practice location

201 SW 14TH St
Bentonville, AR 72712-7449

Mailing address

PO Box 776084
Chicago, IL 60677-6084
Phone (479) 785-2229

Other practice location 1

1333 S Sam Houston Blvd
Houston, MO 65483-2046
Phone (417) 967-1263

Other identifiers 1

IdentifierTypeStateIssuer
200101118MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MO, MA, AR4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20190805001712 RI Practitioner - Family Practice 5092009720 Reassigns benefits to 1 organization
I20210920002259 MO Practitioner - Family Practice 5092009720 Reassigns benefits to 1 organization
I20240410000329 MA Practitioner - Hospitalist 5092009720 Reassigns benefits to 1 organization
I20260327000758 AR Practitioner - Family Practice 5092009720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Berkshire Medical Center IncGroup PAC ID 1355232711, 195 clinicians

Practice addresses (Care Compare)

725 N St
Pittsfield, MA 01201-4109
Phone (413) 447-2000

Hospital & facility affiliations

  • Berkshire Medical Center Hospital, Pittsfield, MA, CCN 220046
  • North Adams Regional Hospital Corporation Hospital, North Adams, MA, CCN 221304
  • Fairview Hospital Hospital, Great Barrington, MA, CCN 221302
  • Baystate Medical Center Hospital, Springfield, MA, CCN 220077

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-19686ARMDFamily Medicine Physician
2021030592MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thundermist Health Center CurrentSince Aug 1, 2019 Accepting new patients
Texas County Memorial Hospital Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Berkshire Medical Center, Inc CurrentSince Feb 8, 2024 Accepting new patients
Berkshire Medical Center Inc. CurrentSince Feb 8, 2024 Accepting new patients
Thundermist Health Center CurrentSince Aug 1, 2019 Accepting new patients
Texas County Memorial Hospital Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Tallah Medical Ar PLLC Family Medicine Current Accepting new patients
Skaggs Community Hospital Association Past Accepting new patients

Locations

201 SW 14th St
Bentonville, AR 72712
Phone (479) 785-2229

725 North St
Pittsfield, MA 01201
Phone (413) 447-2839

1333 S Sam Houston Blvd
Houston, MO 65483
Phone (417) 967-3311

25 John a Cummings Way
Ste 302
Woonsocket, RI 02895

450 Clinton St
Woonsocket, RI 02895

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DCBEAA

Organizations & group practices 9

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.

Hospital & facility affiliations 5

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": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774396800000",
    "number": "1609225499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "479-785-2229",
            "fax_number": "479-314-3185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SW 14TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127449",
            "telephone_number": "479-785-2229",
            "fax_number": "479-314-3185"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1333 S Sam Houston Blvd",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "MO",
            "postal_code": "654832046",
            "country_code": "US",
            "telephone_number": "417-967-1263",
            "fax_number": "417-967-1393",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TALLAH",
        "first_name": "CLARISSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-13",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2021030592",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-19686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200101118",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.