NPIMap

Organization Active NPI

Radiologists of Russellville PA

  • Diagnostic Radiology Physician
  • Russellville, AR
National Provider Identifier
1699744326
Registry record updated Jan 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGISTS OF RUSSELLVILLE PA
Practice address
3301 W Main PL
Russellville, AR 72801-2334
Phone
(479) 968-7930
Fax
(479) 968-1673
NPI assigned
Mar 15, 2006
Last updated
Jan 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2019

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

Authorized official

Name
Dr. Jeffrey Hale, M.D.NPI 1457301418
Title
President Partner
Phone
(479) 968-7930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X AR Primary

Addresses

Primary practice location

3301 W Main PL
Russellville, AR 72801-2334

Mailing address

P.O. Box 9178
Russellville, AR 72811
Phone (479) 968-7930

Other identifiers 2

IdentifierTypeStateIssuer
103880002MedicaidAR
56763OtherARARKANSAS BCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070522000192 AR Part B Supplier - Clinic/Group Practice 4385741685 Receives reassigned benefits from 32 practitioners
Practice locations: Clarksville, AR; Danville, AR; Russellville, AR

National Provider Directory

National Provider Directory

Locations

601 W McKennon St
Clarksville, AR 72830
Phone (479) 754-5393

3301 W Main Pl
Russellville, AR 72801
Phone (855) 498-6768

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547164800000",
    "number": "1699744326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 9178",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "72811",
            "telephone_number": "479-968-7930",
            "fax_number": "479-968-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 W MAIN PL",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012334",
            "telephone_number": "479-968-7930",
            "fax_number": "479-968-1673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGISTS OF RUSSELLVILLE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2019-01-11",
        "status": "A",
        "authorized_official_last_name": "HALE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT PARTNER",
        "authorized_official_telephone_number": "479-968-7930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103880002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS BCBS",
            "identifier": "56763",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2019; 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.