Individual provider Active NPI

Dana Lynne Burchfield, APN

  • Gerontology Nurse Practitioner
  • Bentonville, AR
National Provider Identifier
1821042300
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
A001803 Issued in AR
Practice address
3000 NW a St
Washington Regional Diagnostic Clinic
Bentonville, AR 72712-3985
Phone
(479) 268-3050
Fax
(479) 273-0050
NPI assigned
May 20, 2006
Last updated
Jul 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X A001803 AR Primary

Addresses

Primary practice location

3000 NW a St
Washington Regional Diagnostic Clinic
Bentonville, AR 72712-3985

Mailing address

12 E Appleby Rd
Clinic Administration
Fayetteville, AR 72703-3901
Phone (479) 463-1704

Other identifiers 1

IdentifierTypeStateIssuer
158940758MedicaidAR

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041005000956 AR Practitioner - Nurse Practitioner 5294794327 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A001803ARMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Icp Arkansas Aco Billing LLC CurrentSince May 7, 2021 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Mar 11, 2025 Accepting new patients
Northwest Physicians LLC Past Accepting new patients
Icarepro of Texas, PA Past Accepting new patients

Locations

8050 Counts Massie Rd
Ste B
Maumelle, AR 72113
Phone (501) 492-0099

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1821042300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "CLINIC ADMINISTRATION",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-1704",
            "fax_number": "479-463-7864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NW A ST",
            "address_2": "WASHINGTON REGIONAL DIAGNOSTIC CLINIC",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123985",
            "telephone_number": "479-268-3050",
            "fax_number": "479-273-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURCHFIELD",
        "first_name": "DANA",
        "middle_name": "LYNNE",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-20",
        "last_updated": "2024-07-23",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AR",
            "license": "A001803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158940758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.