NPIMap

Organization Active NPI

Washington Regional Medical System

Doing business as Northwest Arkansas Neurosurgery Clinic - Washington Regional

  • Neurological Surgery Physician
  • Fayetteville, AR
National Provider Identifier
1851754345
Registry record updated Jun 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
WASHINGTON REGIONAL MEDICAL SYSTEM
Doing business as
Northwest Arkansas Neurosurgery Clinic - Washington Regional
Practice address
3561 Johnson Mill Blvd
Suite 101
Fayetteville, AR 72704
Phone
(479) 404-4500
Fax
(479) 404-4510
NPI assigned
Apr 1, 2016
Last updated
Jun 27, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
WASHINGTON REGIONAL MEDICAL SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 27, 2018

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

Authorized official

Name
Daniel R Eckels
Title
Cfo
Phone
(479) 463-2825

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

3561 Johnson Mill Blvd
Suite 101
Fayetteville, AR 72704

Mailing address

3561 Johnson Mill Blvd
Suite 101
Fayetteville, AR 72704
Phone (479) 404-4500

Other names 1

  • Northwest Arkansas Neurosurgery Clinic - Washington Regional Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100130000001 AR Part B Supplier - Clinic/Group Practice 8820995434 Receives reassigned benefits from 117 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springdale, AR; Fayetteville, AR; Harrison, AR; Lincoln, AR; Lowell, AR; Siloam Springs, AR; Berryville, AR; Bentonville, AZ…

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

National Provider Directory

National Provider Directory
Part of
Nwa Clinic for Women

Practitioners & affiliated clinicians

Practitioners 5

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": "1459468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530057600000",
    "number": "1851754345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3561 JOHNSON MILL BLVD",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72704",
            "telephone_number": "479-404-4500",
            "fax_number": "479-404-4510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3561 JOHNSON MILL BLVD",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72704",
            "telephone_number": "479-404-4500",
            "fax_number": "479-404-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WASHINGTON REGIONAL MEDICAL SYSTEM",
        "enumeration_date": "2016-04-01",
        "last_updated": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "ECKELS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "479-463-2825"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Arkansas Neurosurgery Clinic - Washington Regional",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; 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.