Timothy Y. Maryanov, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

E7752 Issued in AR

Practice address

9616 Rogers Ave
Fort Smith, AR 72903-5769

Phone

(479) 242-3310

Fax

(479) 439-8868

NPI assigned

Apr 26, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

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 1

Specialty

Neurosurgery

Education

University of California, San Diego School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: fortneuro.timothymaryanov@137169.advancedmd-direct.com
• Direct secure messaging: timothy.maryanov.1@29002.direct.athenahealth.com

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.

• Fort Neuro

  • Neurological Surgery Physician
  • Fort Smith, AR
  • NPI 1932619327
  NPD (past) Authorized official
• Cooper Clinic PA

  • Multi-Specialty Clinic/Center
  • Fort Smith, AR
  • NPI 1154341931
  NPD (past)
• Radiologists PA

  dba Prime Medical Imaging

  • Diagnostic Radiology Physician
  • Fort Smith, AR
  • NPI 1780651117
  NPD (past)
• University Specialty Clinics Neurosurgery

  • Neurological Surgery Physician
  • Columbia, SC
  • NPI 1740450915
  NPD (past)

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677542400000",
    "number": "1629298500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9616 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035769",
            "telephone_number": "479-551-2127",
            "fax_number": "479-439-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9616 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035769",
            "telephone_number": "479-242-3310",
            "fax_number": "479-439-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARYANOV",
        "first_name": "TIMOTHY",
        "middle_name": "Y.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "SC",
            "license": "LL33444",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "AR",
            "license": "E7752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195532001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guadalupe Martinez Gonzalez, COTA/L
• Angelo Martinez, PT
• Chalice J Martinez, OT
• Jennifer Stephanie Martinez
• Maria Martinez, MHPP
• Denning Nyakeri Masara, M.D
• Hannah Maurine Masingale, OTS
• Laney Mason
• Regina Ann Mason, LPN
• Robert Mason, MHPP

• Neurological Surgery Physician in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Neurological Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.
• 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.