NPIMap

Organization Active NPI

Washington Regional Medical System

Doing business as Johnson Urgent Care - Washington Regional

  • General Practice Physician
  • Fayetteville, AR
National Provider Identifier
1699139345
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
WASHINGTON REGIONAL MEDICAL SYSTEM
Doing business as
Johnson Urgent Care - Washington Regional
Practice address
3561 Johnson Mill Blvd
Suite 102
Fayetteville, AR 72703
Phone
(479) 463-4900
Fax
(479) 463-4910
NPI assigned
Apr 8, 2016
Last updated
May 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Authorized official

Name
Dan Eckels
Title
Cfo
Phone
(479) 968-8279

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

3561 Johnson Mill Blvd
Suite 102
Fayetteville, AR 72703

Mailing address

PO Box 550
Lowell, AR 72745
Phone (479) 463-7775

Other names 1

  • Johnson Urgent Care - Washington Regional Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100130000001 AR Part B Supplier - Clinic/Group Practice 8820995434 Receives reassigned benefits from 117 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springdale, AR; Fayetteville, AR; Harrison, AR; Lincoln, AR; Lowell, AR; Siloam Springs, AR; Berryville, AR; Bentonville, AZ…

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory

Locations

3561 Johnson Mill Blvd
Ste 102
Fayetteville, AR 72704
Phone (479) 404-4900

Practitioners & affiliated clinicians

Practitioners 1

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": "1460073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1699139345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "72745",
            "telephone_number": "479-463-7775",
            "fax_number": "479-463-7187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3561 JOHNSON MILL BLVD",
            "address_2": "SUITE 102",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-463-4900",
            "fax_number": "479-463-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-08",
        "last_updated": "2018-05-15",
        "status": "A",
        "authorized_official_last_name": "ECKELS",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "479-968-8279"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson Urgent Care - Washington Regional",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Johnson Urgent Care - Washington Regional",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.