Mercy Clinic Springfield Communities
Organization Active NPI Diagnostic Radiology Physician · Berryville, AR
NPI 1720022510 · NPPES record last updated Apr 30, 2025
Key facts
- NPI
- 1720022510
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- R2954 (AR)
- Legal business name
- MERCY CLINIC SPRINGFIELD COMMUNITIES
- Practice address
- 214 Carter St
Berryville, AR 72616-4303 - Phone
- (870) 423-5263
- Fax
- (870) 423-5227
- NPI assigned
- Jun 15, 2006
- Organization subpart
- No
Authorized official
- Name
- BJ Roberts
- Title
- Cfo
- Phone
- (417) 820-7363
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 8
Practitioners 23
-
Matthew Aaron Cozart, M.D.
-
Jonathan Fausett, D.O
-
Julia Horton-Bertrand, M.D.
-
Dana Howard, APN
-
James P Irwin, DO
-
Hunter Judkins, M.D.
-
Mark John Perna, M.D.
-
Tyler Worth Troutman, M.D.
-
Miricle Anderson, NP
-
Blake A Little, M.D.
-
Gerald J Ondr, MD
-
Jesse G. Taylor, M.D.
-
Milo Nelson Warner, D.O.
-
Wendy R Jones, MD
-
Michael Marvin, M.D.
-
Nadav Sharon, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090626000412 | AR | Part B Supplier - Clinic/Group Practice | 7416865845 |
Receives reassigned benefits from 18 practitioners 6 other NPIs on this enrollment Practice locations: Green Forest, AR; Omaha, AR; Eureka Springs, AR; Berryville, AR |
National Provider Directory
- Tax ID family
- Springfield Clinic Nucl
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | R2954 | AR | Yes |
Addresses
Primary practice location
214 Carter St
Berryville, AR 72616-4303
Mailing address
PO Box 505164
Saint Louis, MO 63150-5164
Phone (417) 829-4620
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 148815002 | Medicaid | AR | |
| 500268008 | Medicaid | MO |
Other names
- MERCY RADIOLOGY BERRYVILLE
Other providers in Berryville, AR
- Laura Susan Menees
- Mercy Clinic Joplin LLC
- Mercy Clinic Springfield Communities
- Mercy Clinic Springfield Communities
- Mercy Clinic Springfield Communities
- Mercy Clinic Springfield Communities
- Mercy Clinic-Springfield Communities
- Mercy Health Northwest Arkansas Communities
- Mercy Home Health Berryville
- Mercy Home Health Berryville
All providers in Berryville, AR · Diagnostic Radiology Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.