Individual provider Active NPI

Jasper Ahmad Campbell

  • In Home Supportive Care Agency
  • Fayetteville, AR
National Provider Identifier
1770090243
Registry record updated Apr 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
AR5510 Issued in AR
Practice address
31 E Center St Ste 200J
Fayetteville, AR 72701-5348
Phone
(479) 301-8427
NPI assigned
Jan 5, 2018
Last updated
Apr 8, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X AR5510 AR Primary

Addresses

Primary practice location

31 E Center St Ste 200J
Fayetteville, AR 72701-5348

Mailing address

715 Carlton St
Springdale, AR 72762-5103
Phone (479) 231-6845

Other practice location 1

715 Carlton St
Springdale, AR 72762-5103
Phone (479) 361-3073

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
AR5510ARMDIn Home Supportive Care Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Momentum Health Industries Inc In Home Supportive Care Current Accepting new patients

Organizations & group practices 1

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": "1515110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554681600000",
    "number": "1770090243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 CARLTON ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727625103",
            "telephone_number": "479-231-6845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 E CENTER ST STE 200J",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727015348",
            "telephone_number": "479-301-8427"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "715 Carlton St",
            "address_purpose": "LOCATION",
            "city": "Springdale",
            "state": "AR",
            "postal_code": "727625103",
            "country_code": "US",
            "telephone_number": "479-361-3073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "JASPER",
        "middle_name": "AHMAD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-05",
        "last_updated": "2019-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "AR",
            "license": "AR5510",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.