NPIMap

Individual provider Active NPI

Van H De Bruyn, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Little Rock, AR
National Provider Identifier
1871518522
Registry record updated Jan 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
E-1621 Issued in AR
Practice address
11220 Executive Center Dr Ste 200
Little Rock, AR 72211
Phone
(501) 399-4212
Fax
(501) 868-7551
NPI assigned
Jul 13, 2006
Last updated
Jan 12, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X E-1621 AR
Clinical Cardiac Electrophysiology Physician 207RC0001X E-1621 AR Primary

Addresses

Primary practice location

11220 Executive Center Dr Ste 200
Little Rock, AR 72211

Mailing address

12 Spring Valley LN
Little Rock, AR 72223-4494
Phone (501) 399-4212

Other practice location 1

1000 Hwy 35 N
suite 8
Benton, AR 72019-2351
Phone (501) 315-4008

Other identifiers 2

IdentifierTypeStateIssuer
133844001MedicaidAR
89-V554OtherARMALP INS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, WI, LA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040105000301 AR Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0446159966 Reassigns benefits to 2 organizations
I20190207002894 WI Practitioner - Cardiovascular Disease (Cardiology) 0446159966 Reassigns benefits to 2 organizations
I20240607000820 LA Practitioner - Cardiovascular Disease (Cardiology) 0446159966 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Iowa, RJ & L Carver College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Glen D. Hurlston, M.D., ApmcGroup PAC ID 3779557541, 26 clinicians
Allegiance Hospital of Many, LLCGroup PAC ID 3274607551, 40 clinicians
CLHG-LeesvilleGroup PAC ID 4082963301, 25 clinicians

Practice addresses (Care Compare)

1020 Fertitta Blvd
Leesville, LA 71446-4645

1020 W Fertita Blvd
Leesville, LA 71446-4645
Phone (337) 239-9041

12060 Texas Hwy
Many, LA 71449-5605
Phone (318) 256-9002

240 Highland Dr
Many, LA 71449-3718
Phone (318) 256-7380

506 S 6TH St
Leesville, LA 71446-4482
Phone (337) 239-0989

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-1621ARMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allegiance Hospital of Many,LLC CurrentSince Mar 30, 2024 Accepting new patients
Heart Clinic Arkansas Cardiovascular Disease CurrentSince Jan 1, 2006 Accepting new patients
St. Vincent Infirmary Medical Center Current Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Apr 10, 2019 Accepting new patients
CLHG-Leesville CurrentSince Apr 22, 2024 Accepting new patients
Glen D. Hurlston, M.D., Apmc CurrentSince May 4, 2024 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Apr 10, 2019 Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Jan 16, 2019 Accepting new patients
Sark Opl Cardiovascular Disease CurrentSince Jul 7, 2020 Accepting new patients
South Arkansas Cardiology, P.L.L.C. Cardiovascular Disease CurrentSince Jan 1, 2021 Accepting new patients
Allegiance Hospital of Many, LLC CurrentSince Mar 30, 2024 Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Jan 16, 2019 Accepting new patients
CLHG-Leesville LLC CurrentSince Apr 22, 2024 Accepting new patients
CLHG-Leesville Current Accepting new patients
Allegiance Hospital of Many, LLC Past Accepting new patients
Advanced Spine and Pain Centers Inc Past Accepting new patients
Central Arkansas Spine Specialists Past Accepting new patients
Baptist Health Cardiovascular Disease Past Accepting new patients
Byrd Medical Clinic Inc Past Accepting new patients
Allegiance Hospital of Many, LLC Past Accepting new patients

Locations

10100 Kanis Rd
Little Rock, AR 72205
Phone (501) 255-6000

2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680

1507 Linwood Dr
Paragould, AR 72450
Phone (870) 239-8105

7200 S Hazel St
Pine Bluff, AR 71603
Phone (870) 534-2900

1708 N Buerkle St
Stuttgart, AR 72160
Phone (870) 659-8050

29980 Network Pl
Chicago, IL 60673

1020 W Fertitta Blvd
Leesville, LA 71446
Phone (337) 239-5278

506 S 6th St
Leesville, LA 71446
Phone (337) 239-0989

12060 Texas Hwy
#3
Many, LA 71449
Phone (318) 256-9002

240 Highland Dr
Many, LA 71449
Phone (318) 256-5691

395 S Capitol St
Many, LA 71449
Phone (318) 256-2000

2251 N Shore Dr
Rhinelander, WI 54501
Phone (715) 361-2300

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

900 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

3301 Cranberry Blvd
Weston, WI 54476
Phone (715) 393-2100

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GBHCBD
  • Direct secure messaging: van.de.bruyn.1@17837.direct.athenahealth.com
  • Direct secure messaging: van.debruyn.1@19794.direct.athenahealth.com

Organizations & group practices 21

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.

View all 21

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547251200000",
    "number": "1871518522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 SPRING VALLEY LN",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722234494",
            "telephone_number": "501-399-4212",
            "fax_number": "501-868-7551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11220 EXECUTIVE CENTER DR STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72211",
            "telephone_number": "501-399-4212",
            "fax_number": "501-868-7551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Hwy 35 N",
            "address_2": "suite 8",
            "address_purpose": "LOCATION",
            "city": "Benton",
            "state": "AR",
            "postal_code": "720192351",
            "country_code": "US",
            "telephone_number": "501-315-4008",
            "fax_number": "501-315-3411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE BRUYN",
        "first_name": "VAN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2019-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AR",
            "license": "E-1621",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "AR",
            "license": "E-1621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133844001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MALP INS",
            "identifier": "89-V554",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.