Individual provider Active NPI

James J Brantley, DPM

  • Podiatrist
  • Fayetteville, AR
National Provider Identifier
1720083033
Registry record updated May 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
152 Issued in AR
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, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
152OtherARSTATE PODIATRY LICENSE
11443421OtherARCAQH 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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041213001052 AR Practitioner - Podiatry 8123085990

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
152ARMDPodiatrist

Interoperability endpoints

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.