Individual provider Active NPI

Roland Crisologo Vizconde, M.D.

  • Internal Medicine Physician
  • Fort Smith, AR
National Provider Identifier
1801104682
Registry record updated Aug 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E-8171 Issued in AR
Practice address
7301 Rogers Ave
Fort Smith, AR 72903-4100
Phone
(479) 314-6000
NPI assigned
Sep 15, 2010
Last updated
Aug 16, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OH
Internal Medicine Physician 207R00000X E-8171 AR Primary

Addresses

Primary practice location

7301 Rogers Ave
Fort Smith, AR 72903-4100

Mailing address

7301 Rogers Ave
Fort Smith, AR 72903-4100
Phone (479) 314-6000

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
I20130919000053 AR Practitioner - Internal Medicine 5698919363 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7001 Rogers Ave
Suite 200
Fort Smith, AR 72903-4022
Phone (479) 314-4620

7301 Rogers Ave
Fort Smith, AR 72903-4100
Phone (479) 314-5175

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-8171ARMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Fort Smith Communities CurrentSince Aug 5, 2013 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Aug 5, 2013 Accepting new patients
Mercy Hospital Fort Smith Past Accepting new patients

Locations

5401 Ellsworth Rd
Fort Smith, AR 72903
Phone (479) 314-1101

7001 Rogers Ave
Ste 200
Fort Smith, AR 72903
Phone (479) 314-4620

7301 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-4600

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376611200000",
    "number": "1801104682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729034100",
            "telephone_number": "479-314-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729034100",
            "telephone_number": "479-314-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIZCONDE",
        "first_name": "ROLAND",
        "middle_name": "CRISOLOGO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-15",
        "last_updated": "2013-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-8171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.