Individual provider Active NPI

Terry F Sutterfield, M.D.

  • Family Medicine Physician
  • Springdale, AR
National Provider Identifier
1689679573
Registry record updated Jan 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C6677 Issued in AR
Practice address
614 E Emma Ave
Suite 300
Springdale, AR 72764-4634
Phone
(479) 751-7417
Fax
(479) 751-4898
NPI assigned
Jun 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2017

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 49304 CO
Family Medicine Physician 207Q00000X C6677 AR Primary

Addresses

Primary practice location

614 E Emma Ave
Suite 300
Springdale, AR 72764-4634

Mailing address

614 E Emma Ave
Suite 300
Springdale, AR 72764-4634
Phone (479) 751-7417

Other identifiers 3

IdentifierTypeStateIssuer
24202355MedicaidCO
55127OtherARBLUE CROSS AR
109686001MedicaidAR

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080312000377 AR Practitioner - Family PracticePractitioner - Hospice/Palliative Care 8325123524

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C6677ARMDFamily Medicine Physician
49304COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Circle of Life Family Medicine CurrentSince Sep 3, 2012 Accepting new patients
Boston Mountain Rural Health Center Inc Past Accepting new patients

Locations

901 Jones Rd
Springdale, AR 72762
Phone (479) 750-6632

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1689679573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVE",
            "address_2": "SUITE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644634",
            "telephone_number": "479-751-7417",
            "fax_number": "479-751-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVE",
            "address_2": "SUITE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644634",
            "telephone_number": "479-751-7417",
            "fax_number": "479-751-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTERFIELD",
        "first_name": "TERRY",
        "middle_name": "F",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "49304",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C6677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "24202355",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AR",
            "identifier": "55127",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109686001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springdale, AR

Sources for this page

Verify at the official NPI Registry.