Active NPI
Varghese Edattukaren, MD
- Family Medicine Physician
- Walnut Ridge, AR
National Provider Identifier
1912930967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R4370
- Practice address
- 201 Colonial Dr
Walnut Ridge, AR 72476-1410 - Phone
- (870) 886-5507
- Fax
- (870) 886-5632
- NPI assigned
- Jul 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R4370 | AR | Primary |
Addresses
Primary practice location
201 Colonial Dr
Walnut Ridge, AR 72476-1410
Mailing address
PO Box 83
1300 Creason Road
Corning, AR 72422-0083
Phone (870) 857-3399
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122364001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389830400000",
"number": "1912930967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 83",
"address_2": "1300 CREASON ROAD",
"city": "CORNING",
"state": "AR",
"postal_code": "724220083",
"telephone_number": "870-857-3399",
"fax_number": "870-857-9934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 COLONIAL DR",
"city": "WALNUT RIDGE",
"state": "AR",
"postal_code": "724761410",
"telephone_number": "870-886-5507",
"fax_number": "870-886-5632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDATTUKAREN",
"first_name": "VARGHESE",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-09",
"last_updated": "2014-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AR",
"license": "R4370",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "122364001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Walnut Ridge, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.