NPIMap

Organization Active NPI

Mercy Health Northwest Arkansas Communities

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Rogers, AR
National Provider Identifier
1619219474
Registry record updated Apr 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X
Legal business name
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
Practice address
2708 S Rife Medical LN Ste T20
Rogers, AR 72758-1469
Phone
(479) 338-3720
Fax
(479) 338-3740
NPI assigned
Mar 20, 2013
Last updated
Apr 2, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2018

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

Authorized official

Name
Benny J Stover
Title
Vice President-Finance
Phone
(479) 338-2230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QH0002X Primary

Addresses

Primary practice location

2708 S Rife Medical LN Ste T20
Rogers, AR 72758-1469

Mailing address

2708 Rife Medical LN
Suite T20
Rogers, AR 72758-1452
Phone (479) 338-3720

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031216000788 AR Part B Supplier - Clinic/Group Practice 0648177873 Receives reassigned benefits from 485 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rogers, AR; Springdale, AR; Tontitown, AR; Bentonville, AR; Berryville, AR; Centerton, AR; Eureka Springs, AR; Green Forest, AR…

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

2708 S Rife Medical Ln
Ste T20
Rogers, AR 72758
Phone (479) 338-3080

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522627200000",
    "number": "1619219474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 RIFE MEDICAL LN",
            "address_2": "SUITE T20",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581452",
            "telephone_number": "479-338-3720",
            "fax_number": "479-338-3740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2708 S RIFE MEDICAL LN STE T20",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581469",
            "telephone_number": "479-338-3720",
            "fax_number": "479-338-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-20",
        "last_updated": "2018-04-02",
        "status": "A",
        "authorized_official_last_name": "STOVER",
        "authorized_official_first_name": "BENNY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT-FINANCE",
        "authorized_official_telephone_number": "479-338-2230"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2018; 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.