Bohannan Anesthesia PLLC

Primary specialty

Ophthalmologic Surgery Clinic/CenterTaxonomy code 261QS0132X

Legal business name

BOHANNAN ANESTHESIA PLLC

Practice address

3737 W Walnut St
Rogers, AR 72756-1839

Phone

(479) 246-1751

NPI assigned

Nov 13, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Holly Rae Bohannan, CRNA, MSNANPI 1326097890

Title

Owner

Phone

(479) 530-6649

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Holly Bohannan, CRNA MSNA

  • Certified Registered Nurse Anesthetist
  • Bentonville, AR
  • NPI 1326097890
  Medicare reassignment NPD Authorized official
• Shannon Nguyen, CRNA

  • Certified Registered Nurse Anesthetist
  • Springdale, AR
  • NPI 1053890327
  NPD (past)

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542067200000",
    "number": "1740758366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12688 MILLER CHURCH RD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727129041",
            "telephone_number": "479-530-6649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 W WALNUT ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727561839",
            "telephone_number": "479-246-1751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOHANNAN ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-13",
        "last_updated": "2018-11-13",
        "status": "A",
        "authorized_official_last_name": "BOHANNAN",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-530-6649",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRNA, MSNA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BREAST CARE",
            "identifier": "771165401",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "914302906",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200330120",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163654001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Branden Shane Blume, PT, DPT
• Mallory Leigh Bockelman, LPC
• Body Positive Therapy, PLLC
• Jennifer Diane Boehm, LPC
• Jennifer Ann Boggs, WHNP
• Scotty L Bolding, DDS
• Megan Michelle Bolin
• Sara Elizabeth Bond, OTR/L
• Daisy Bonilla
• Daizy Bonilla, MHPP

• Ophthalmologic Surgery Clinic/Center in Rogers, AR
• Providers in Rogers, AR by specialty
• Ophthalmologic Surgery Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; 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.