NPIMap

Organization Active NPI

Arkansas Health Group

Doing business as Baptist Health Specialty Clinic Malvern

  • Surgery Physician
  • Malvern, AR
National Provider Identifier
1780015958
Registry record updated Apr 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
N-8012 Issued in AR
Legal business name
ARKANSAS HEALTH GROUP
Doing business as
Baptist Health Specialty Clinic Malvern
Practice address
1002 Schneider Dr Ste 103
Malvern, AR 72104-4823
Phone
(501) 332-1012
Fax
(501) 332-7074
NPI assigned
Dec 12, 2013
Last updated
Apr 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2019

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

Authorized official

Name
Will Rusher
Title
Ceo
Phone
(501) 812-7509

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X C-5483 AR
Surgery Physician 208600000X N-8012 AR Primary

Addresses

Primary practice location

1002 Schneider Dr Ste 103
Malvern, AR 72104-4823

Mailing address

11001 Executive Center Dr Ste 200
Little Rock, AR 72211-4393
Phone (501) 812-7215

Other practice location 1

1002 Schneider Dr
Suite 102
Malvern, AR 72104-4816
Phone (501) 332-1012

Other names 1

  • Baptist Health Specialty Clinic Malvern Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141031000298 AR Part B Supplier - Clinic/Group Practice 7911802079 Receives reassigned benefits from 2 practitioners
Practice locations: Malvern, AR

National Provider Directory

National Provider Directory
Tax ID family
Jeffrey S Mayfield49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

Organizations that report the same tax identification number in the National Provider Directory.

View all 48

Member of 1

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

  • Baptist Health

    dba Baptist Health Family Clinic - Russellville

    • Rural Health Clinic/Center
    • Russellville, AR
    • NPI 1689467102

    Member Of

    NPD member

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1780015958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DR STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114393",
            "telephone_number": "501-812-7215",
            "fax_number": "501-812-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 SCHNEIDER DR STE 103",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721044823",
            "telephone_number": "501-332-1012",
            "fax_number": "501-332-7074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1002 Schneider Dr",
            "address_2": "Suite 102",
            "address_purpose": "LOCATION",
            "city": "Malvern",
            "state": "AR",
            "postal_code": "721044816",
            "country_code": "US",
            "telephone_number": "501-332-1012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ARKANSAS HEALTH GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-12",
        "last_updated": "2019-04-11",
        "status": "A",
        "authorized_official_last_name": "RUSHER",
        "authorized_official_first_name": "WILL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "501-812-7509"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AR",
            "license": "C-5483",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "N-8012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Health Specialty Clinic Malvern",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Malvern, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; 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.