NPIMap

Organization Active NPI

St Marys Physician Services, LLC

Doing business as Cardiology Associates of North Central Arkansas

  • Interventional Cardiology Physician
  • Russellville, AR
National Provider Identifier
1720356207
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
Legal business name
ST MARYS PHYSICIAN SERVICES, LLC
Doing business as
Cardiology Associates of North Central Arkansas
Practice address
2205 W Main St
Russellville, AR 72801-2759
Phone
(479) 968-4311
Fax
(479) 968-4399
NPI assigned
Dec 12, 2011
Last updated
Sep 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Authorized official

Name
Chaarlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X NU Primary

Addresses

Primary practice location

2205 W Main St
Russellville, AR 72801-2759

Mailing address

PO Box 9355
Belfast, ME 04915-9355
Phone (479) 968-4311

Other names 1

  • Cardiology Associates of North Central Arkansas Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040609000759 AR Part B Supplier - Clinic/Group Practice 4981698032 Receives reassigned benefits from 137 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atkins, AR; Dardanelle, AR; Dover, AR; Russellville, AR

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2205 W Main St
Russellville, AR 72801
Phone (479) 890-2654

Practitioners & affiliated clinicians

Practitioners 198

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 198

NPI Registry JSON

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1720356207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9355",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049159355",
            "telephone_number": "479-968-4311",
            "fax_number": "479-968-4399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012759",
            "telephone_number": "479-968-4311",
            "fax_number": "479-968-4399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARYS PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-12",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHAARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardiology Associates of North Central Arkansas",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cardiology Associates of North Central Arkansas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 26, 2024; 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.