Ozark Orthopaedics, P.a.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

MC-0077 Issued in AR

Legal business name

OZARK ORTHOPAEDICS, P.A.

Doing business as

Ozark Orthopaedic and Sports Medicine

Practice address

3317 N Wimberly Dr
Fayetteville, AR 72703-4056

Phone

(479) 521-2752

Fax

(479) 521-4603

NPI assigned

Jun 8, 2006

Last updated

Apr 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy Davenport

Title

Chief Operating Officer

Phone

(479) 587-3149

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 2

• OZARK ORTHOPAEDIC AND SPORTS MEDICINE Doing business as
• Orthopaedic Clinic, Ltd. Former legal business name

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Ozark Orthopaedics, P.a.

  dba Ozark Orthopaedics

  • Orthopaedic Surgery Physician
  • Bentonville, AR
  • NPI 1235573577

  2860477189

  Same PAC ID
• Ozark Orthopaedics, P.a.

  dba Ozark Orthopaedics

  • Orthopaedic Surgery Physician
  • Siloam Springs, AR
  • NPI 1649614231

  2860477189

  Same PAC ID

Locations

Practitioners 88

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.

• Shannon L Astin, PT

  • Physical Therapist
  • Fayetteville, AR
  • NPI 1437290988
  Medicare reassignment Care Compare group NPD
• Katelyn M Bakunas, PA

  • Physician Assistant
  • Fayetteville, AR
  • NPI 1275941312

  Orthopaedic Surgery

  Medicare reassignment Care Compare group NPD
• Robert Bryan Benafield Jr., M.D.

  • Orthopaedic Hand Surgery Physician
  • Fayetteville, AR
  • NPI 1780656850

  Orthopaedic Surgery

  Medicare reassignment Care Compare group NPD
• Laura Hadley Buergler, DPT

  • Physical Therapist
  • Bentonville, AR
  • NPI 1467882084
  Medicare reassignment Care Compare group NPD
• Mathew Jack Coker, M.D.

  • Orthopaedic Surgery Physician
  • Fayetteville, AR
  • NPI 1053384545
  Medicare reassignment Care Compare group NPD
• Tom Patrick Coker, M.D.

  • Orthopaedic Surgery Physician
  • Fayetteville, AR
  • NPI 1245203736
  Medicare reassignment Care Compare group NPD
• Jonathan Dale Edward Creech, MD

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Fayetteville, AR
  • NPI 1922495779
  Medicare reassignment Care Compare group NPD
• George W Deimel IV, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Fayetteville, AR
  • NPI 1669603064
  Medicare reassignment Care Compare group NPD
• Logan Jerald Dewhitt, DPT

  • Physical Therapist
  • Fayetteville, AR
  • NPI 1114574142
  Medicare reassignment Care Compare group NPD
• Jacob Edwards, DPT

  • Physical Therapist
  • Fayetteville, AR
  • NPI 1619346848
  Medicare reassignment Care Compare group NPD
• Kelly Nicole Edwards, PT

  • Physical Therapist
  • Fayetteville, AR
  • NPI 1144108754
  Medicare reassignment Care Compare group NPD
• Connor Taylor English, DPT

  • Physical Therapist
  • Fayetteville, AR
  • NPI 1730802091
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1649210584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1608",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72702",
            "telephone_number": "479-521-2752",
            "fax_number": "479-444-6942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3317 N WIMBERLY DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034056",
            "telephone_number": "479-521-2752",
            "fax_number": "479-521-4603"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 N Progress Ave",
            "address_2": "Suite 30",
            "address_purpose": "LOCATION",
            "city": "Siloam Springs",
            "state": "AR",
            "postal_code": "72761",
            "country_code": "US",
            "telephone_number": "479-521-2752",
            "fax_number": "479-521-4603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 N Progress Ave",
            "address_2": "Suite 30",
            "address_purpose": "LOCATION",
            "city": "Siloam Springs",
            "state": "AR",
            "postal_code": "72761",
            "country_code": "US",
            "telephone_number": "479-521-2752",
            "fax_number": "479-521-4603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 N Progress Ave",
            "address_2": "Suite 30",
            "address_purpose": "LOCATION",
            "city": "Siloam Springs",
            "state": "AR",
            "postal_code": "72761",
            "country_code": "US",
            "telephone_number": "479-521-2752",
            "fax_number": "479-521-4603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 W Maple Ave Ste 704",
            "address_purpose": "LOCATION",
            "city": "Springdale",
            "state": "AR",
            "postal_code": "727645378",
            "country_code": "US",
            "telephone_number": "479-521-2752",
            "fax_number": "479-521-4603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 SE Moberly Ln",
            "address_purpose": "LOCATION",
            "city": "Bentonville",
            "state": "AR",
            "postal_code": "727127017",
            "country_code": "US",
            "telephone_number": "479-521-4603",
            "fax_number": "479-521-4603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "146 Passion Play Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Eureka Springs",
            "state": "AR",
            "postal_code": "726329455",
            "country_code": "US",
            "telephone_number": "479-521-2752",
            "fax_number": "479-521-4603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "603-2 N Progress Ave",
            "address_purpose": "LOCATION",
            "city": "Siloam Springs",
            "state": "AR",
            "postal_code": "727614063",
            "country_code": "US",
            "telephone_number": "479-521-2752",
            "fax_number": "479-521-4603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OZARK ORTHOPAEDICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-19",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "479-587-3149"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AR",
            "license": "MC-0077",
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME FOR SILOAM SPRINGS CLINIC",
            "identifier": "205331716",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106296002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OZARK ORTHOPAEDIC AND SPORTS MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OZARK ORTHOPAEDIC AND SPORTS MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Orthopaedic Clinic, Ltd.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Ozark Dermatology Clinic
• Ozark Foot & Ankle PLC
• Ozark Medical Consultants PLLC
• Ozark Mobility Nemt, LLC
• Ozark Orthopaedics, P.a.
• Ozark Radiation Oncology
• Ozark Regional Anesthesia
• Ozark Spinal Associates, PLLC (Millennium Chiropractic & Rehab)
• Ozark Surgical Associates
• Ozarks Neurology

• Orthopaedic Surgery Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Orthopaedic Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; 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.