Active NPI
Gene Bruce Waldon, MD
- Hospitalist Physician
- Bentonville, AR
National Provider Identifier
1790733301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- C4981
- Practice address
- 3000 Medical Center Parkway
Bentonville, AR 72712 - Phone
- (479) 553-2524
- Fax
- (479) 553-2522
- NPI assigned
- May 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD28692 | OR | |
| Hospitalist Physician | 208M00000X | MD28692 | OR | |
| Hospitalist Physician | 208M00000X | C4981 | AR | Primary |
| Internal Medicine Physician | 207R00000X | C4981 | AR |
Addresses
Primary practice location
3000 Medical Center Parkway
Bentonville, AR 72712
Mailing address
3000 Medical Center Parkway
Bentonville, AR 72712
Phone (479) 553-2524
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500601380 | Medicaid | OR |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C4981 | AR | MD | Internal Medicine Physician |
| MD28692 | OR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Aesthetics & Wellness Center PA, Earlmd Family Medicine PA | Past | 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 and National Provider Directory roles.
-
- Family Medicine Physician
- Bentonville, AR
- NPI 1811135809
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360108800000",
"number": "1790733301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 MEDICAL CENTER PARKWAY",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "72712",
"telephone_number": "479-553-2524",
"fax_number": "479-553-2522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 MEDICAL CENTER PARKWAY",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "72712",
"telephone_number": "479-553-2524",
"fax_number": "479-553-2522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDON",
"first_name": "GENE",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2013-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD28692",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "OR",
"license": "MD28692",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "AR",
"license": "C4981",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AR",
"license": "C4981",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500601380",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bentonville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.