Individual provider Active NPI

William Mace Ferguson Jr., CRNA

  • Certified Registered Nurse Anesthetist
  • Little Rock, AR
National Provider Identifier
1780698191
Registry record updated Jun 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
C001089 Issued in AR
Practice address
6119 Midtown Ave
Suite 201
Little Rock, AR 72205-5313
Phone
(501) 664-4532
Fax
(501) 664-4335
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X C001089 AR Primary
Registered Nurse 163W00000X R043052 AR

Addresses

Primary practice location

6119 Midtown Ave
Suite 201
Little Rock, AR 72205-5313

Mailing address

6119 Midtown Ave
Suite 201
Little Rock, AR 72205-5313
Phone (501) 664-4532

Other identifiers 1

IdentifierTypeStateIssuer
138960701MedicaidAR

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
R043052ARMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Midstate Medical Services PA PastSince Aug 7, 2012 Accepting new patients
Barbara Lazerus Crna Ms Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434412800000",
    "number": "1780698191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6119 MIDTOWN AVE",
            "address_2": "SUITE 201",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055313",
            "telephone_number": "501-664-4532",
            "fax_number": "501-664-4335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6119 MIDTOWN AVE",
            "address_2": "SUITE 201",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055313",
            "telephone_number": "501-664-4532",
            "fax_number": "501-664-4335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "WILLIAM",
        "middle_name": "MACE",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2015-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "C001089",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R043052",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "138960701",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; 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.