Individual provider Active NPI

Brian D Mahana

  • Family Nurse Practitioner
  • Fayetteville, AR
National Provider Identifier
1902205248
Registry record updated Feb 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A004167 Issued in AR
Practice address
3211 N. North Hills Blvd.
Suite 110
Fayetteville, AR 72703
Phone
(479) 571-4338
Fax
(479) 571-4015
NPI assigned
Aug 21, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A004167 AR Primary

Addresses

Primary practice location

3211 N. North Hills Blvd.
Suite 110
Fayetteville, AR 72703

Mailing address

PO Box 655
Lowell, AR 72745-0655
Phone (479) 463-7775

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
I20170120000451 AR Practitioner - Nurse Practitioner 4284916628 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington Regional Medical SystemGroup PAC ID 8820995434, 238 clinicians

Practice addresses (Care Compare)

3211 N N Hills Blvd
Suite 110
Fayetteville, AR 72703-5602
Phone (479) 571-4338

Hospital & facility affiliations

  • Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System CurrentSince Aug 1, 2016 Accepting new patients
Washington Regional Medical System CurrentSince Aug 1, 2016 Accepting new patients
Washington Regional Medical System Past Accepting new patients

Locations

3211 N Northhills Blvd
Ste 110
Fayetteville, AR 72703
Phone (479) 571-4338

3344 N Futrall Dr
Fayetteville, AR 72703
Phone (479) 582-7213

Interoperability endpoints

  • Direct secure messaging: bmahana34528@washingtonregional.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518739200000",
    "number": "1902205248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 655",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727450655",
            "telephone_number": "479-463-7775",
            "fax_number": "479-463-7187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3211 N. NORTH HILLS BLVD.",
            "address_2": "SUITE 110",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-571-4338",
            "fax_number": "479-571-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHANA",
        "first_name": "BRIAN",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-21",
        "last_updated": "2018-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A004167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.