NPIMap

Organization Active NPI

ENT and Allergy Center, PA

  • Specialist
  • Fayetteville, AR
National Provider Identifier
1881690238
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MC2362 Issued in AR
Legal business name
ENT AND ALLERGY CENTER, PA
Practice address
2100 N Green Acres Rd
Fayetteville, AR 72703-2807
Phone
(479) 521-0455
Fax
(479) 444-9722
NPI assigned
Jun 21, 2005
Reactivated
Oct 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Authorized official

Name
Mr. Steve Cashman, MD
Title
Owner President
Phone
(479) 521-0455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MC2362 AR Primary

Addresses

Primary practice location

2100 N Green Acres Rd
Fayetteville, AR 72703-2807

Mailing address

2100 N Green Acres Rd
Fayetteville, AR 72703-2807
Phone (479) 521-0455

Other identifiers 2

IdentifierTypeStateIssuer
312133002MedicaidAR
MC2362OtherARMEDICAL LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040712000712 AR Part B Supplier - Clinic/Group Practice 4789662131 Receives reassigned benefits from 5 practitioners
Practice locations: Fayetteville, AR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1881690238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 N GREEN ACRES RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032807",
            "telephone_number": "479-521-0455",
            "fax_number": "479-444-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N GREEN ACRES RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032807",
            "telephone_number": "479-521-0455",
            "fax_number": "479-444-9722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT AND ALLERGY CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-14",
        "deactivation_date": "2005-06-21",
        "reactivation_date": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "CASHMAN",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "479-521-0455",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AR",
            "license": "MC2362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312133002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MC2362",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 27, 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.