Active NPI
James J Brantley, DPM
- Podiatrist
- Fayetteville, AR
National Provider Identifier
1720083033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 152
- Practice address
- 2828 E Millennium PL
Suite 2
Fayetteville, AR 72703-6514 - Phone
- (479) 582-1199
- Fax
- (479) 582-1194
- NPI assigned
- Jun 15, 2005
- Last updated
- May 5, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 152 | AR | Primary |
Addresses
Primary practice location
2828 E Millennium PL
Suite 2
Fayetteville, AR 72703-6514
Mailing address
PO Box 8728
Fayetteville, AR 72703-0013
Phone (479) 582-1199
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 152 | Other | AR | STATE PODIATRY LICENSE |
| 11443421 | Other | AR | CAQH PROVIDER NUMBER |
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041213001052 | AR | Practitioner - Podiatry | 8123085990 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 152 | AR | MD | Podiatrist |
Interoperability endpoints
- drbrantley@ofaap-ar.direct.office.nextgen.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Foot & Ankle Surgery Podiatrist
- Fayetteville, AR
- NPI 1710256003
-
- Foot & Ankle Surgery Podiatrist
- Eureka Springs, AR
- NPI 1962812321
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462406400000",
"number": "1720083033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8728",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727030013",
"telephone_number": "479-582-1199",
"fax_number": "479-582-1194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2828 E MILLENNIUM PL",
"address_2": "SUITE 2",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727036514",
"telephone_number": "479-582-1199",
"fax_number": "479-582-1194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANTLEY",
"first_name": "JAMES",
"middle_name": "J",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-15",
"last_updated": "2016-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "AR",
"license": "152",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE PODIATRY LICENSE",
"identifier": "152",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH PROVIDER NUMBER",
"identifier": "11443421",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}
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 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.