Organization Active NPI

Lonnie Harrison, PA

  • Interventional Cardiology Physician
  • Benton, AR
National Provider Identifier
1881132363
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
C7481 Issued in AR
Legal business name
LONNIE HARRISON, PA
Practice address
3 Medical Park Dr Ste 201
Benton, AR 72015-3725
Phone
(501) 860-7189
Fax
(501) 860-7183
NPI assigned
Feb 6, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Lonnie E Harrison, MDNPI 1003048943
Title
Owner
Phone
(501) 860-7189

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X C7481 AR
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X C7481 AR Primary

Addresses

Primary practice location

3 Medical Park Dr Ste 201
Benton, AR 72015-3725

Mailing address

3 Medical Park Dr Ste 201
Benton, AR 72015-3725
Phone (501) 860-7189

Other identifiers 1

IdentifierTypeStateIssuer
115615001MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170317000975 AR Part B Supplier - Clinic/Group Practice 7618252420 Receives reassigned benefits from 3 practitioners
Practice locations: Benton, AR

National Provider Directory

National Provider Directory

Locations

3 Medical Park Dr
Ste 201
Benton, AR 72015
Phone (501) 337-5678

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1881132363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MEDICAL PARK DR STE 201",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153725",
            "telephone_number": "501-860-7189",
            "fax_number": "501-860-7183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MEDICAL PARK DR STE 201",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153725",
            "telephone_number": "501-860-7189",
            "fax_number": "501-860-7183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONNIE HARRISON, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-06",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "LONNIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-860-7189",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "AR",
            "license": "C7481",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "AR",
            "license": "C7481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115615001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; 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.