Individual provider Active NPI

George Valentine Schaefer, MD

  • Pediatric Adolescent Medicine Physician
  • Bentonville, AR
National Provider Identifier
1700834603
Registry record updated Sep 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
C7531 Issued in AR
Practice address
3101 SE 14TH St
Bentonville, AR 72712-4900
Phone
(479) 636-9234
Fax
(479) 636-0774
NPI assigned
May 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X C7531 AR Primary

Addresses

Primary practice location

3101 SE 14TH St
Bentonville, AR 72712-4900

Mailing address

3101 SE 14TH St
Bentonville, AR 72712-4900
Phone (479) 636-9234

Other identifiers 1

IdentifierTypeStateIssuer
126249001MedicaidAR

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
I20100628000971 AR Practitioner - Pediatric Medicine 9436280872 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C7531ARMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Northwest Arkansas Communities CurrentSince May 18, 2010 Accepting new patients
Mercy Health Northwest Arkansas Communities Current Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince May 18, 2010 Accepting new patients

Locations

3101 SE 14th St
Bentonville, AR 72712
Phone (479) 631-2100

4600 Mercy Ln
Ste 110
Springdale, AR 72762
Phone (479) 338-4400

Interoperability endpoints

  • Direct secure messaging: gschaefer17392@directc.mercy.net

Organizations & group practices 3

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316822400000",
    "number": "1700834603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 SE 14TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124900",
            "telephone_number": "479-636-9234",
            "fax_number": "479-636-0774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 SE 14TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124900",
            "telephone_number": "479-636-9234",
            "fax_number": "479-636-0774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAEFER",
        "first_name": "GEORGE",
        "middle_name": "VALENTINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2011-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "AR",
            "license": "C7531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126249001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.