NPIMap

Organization Active NPI

Ozark Orthopaedics, P.a.

Doing business as Ozark Orthopaedics

  • Orthopaedic Surgery Physician
  • Siloam Springs, AR
National Provider Identifier
1649614231
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
OZARK ORTHOPAEDICS, P.A.
Doing business as
Ozark Orthopaedics
Practice address
603-2 N Progress Ave Ste 600
Siloam Springs, AR 72761-4610
Phone
(479) 524-6188
Fax
(479) 444-6942
NPI assigned
Apr 25, 2013
Last updated
Jul 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Authorized official

Name
Tracy Davenport
Title
Director of Operations
Phone
(479) 587-3149

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Orthopaedic Surgery Physician 207X00000X NU Primary
Physical Medicine & Rehabilitation Physician 208100000X NU

Addresses

Primary practice location

603-2 N Progress Ave Ste 600
Siloam Springs, AR 72761-4610

Mailing address

3317 N Wimberly Dr
Fayetteville, AR 72703-4056
Phone (479) 521-2752

Other identifiers 1

IdentifierTypeStateIssuer
100726900BMedicaidOK

Other names 2

  • OZARK ORTHOPAEDICS Doing business as
  • Orthopaedic Clinic, Ltd. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131021000056 AR DME Supplier - Physician - Orthopedic/Orthopedic Surgery 2860477189 Practice locations: Siloam Springs, AR

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Ozark Ortho Sports Me2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

603-2 N Progress Ave
Ste 600
Siloam Springs, AR 72761
Phone (479) 521-2752

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593993600000",
    "number": "1649614231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603-2 N PROGRESS AVE STE 600",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727614610",
            "telephone_number": "479-524-6188",
            "fax_number": "479-444-6942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARK ORTHOPAEDICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-25",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "479-587-3149"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100726900B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OZARK ORTHOPAEDICS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OZARK ORTHOPAEDICS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Orthopaedic Clinic, Ltd.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Siloam Springs, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; 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.