Individual provider Active NPI

Daniel Adane Kassa, MD

  • Student in an Organized Health Care Education/Training Program
  • Pine Bluff, AR
National Provider Identifier
1770385270
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1601 W 40TH Ave
Pine Bluff, AR 71603-6069
Phone
(870) 541-7611
NPI assigned
Mar 25, 2025
Last updated
Nov 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X AR Primary

Addresses

Primary practice location

1601 W 40TH Ave
Pine Bluff, AR 71603-6069

Mailing address

1601 W 40TH Ave
Pine Bluff, AR 71603-6069
Phone (870) 541-7611

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250730002092 AR Order and Referring Only - Family PracticePractitioner - Family Practice 2668989906

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1742860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762214400000",
    "number": "1770385270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 W 40TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036069",
            "telephone_number": "870-541-7611",
            "fax_number": "870-541-7618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 W 40TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036069",
            "telephone_number": "870-541-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSA",
        "first_name": "DANIEL",
        "middle_name": "ADANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-25",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

Verify at the official NPI Registry.