NPIMap

Individual provider Active NPI

Adalberto R Fonticiella, M.D.

  • Internal Medicine Physician
  • Paragould, AR
National Provider Identifier
1922088269
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C-6766 Issued in AR
Practice address
1000 West Kingshighway
Suite 12
Paragould, AR 72450-8894
Phone
(870) 236-6930
Fax
(870) 239-8065
NPI assigned
Jan 20, 2006
Last updated
Mar 20, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X C-6766 AR Primary
Surgery Physician 208600000X C-6766 AR

Addresses

Primary practice location

1000 West Kingshighway
Suite 12
Paragould, AR 72450-8894

Mailing address

1000 W Kingshighway
Suite 12
Paragould, AR 72450-4141
Phone (870) 236-6930

Other identifiers 1

IdentifierTypeStateIssuer
157456002MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050725001006 AR Practitioner - Internal MedicinePractitioner - Family Practice 9739155615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1000 W Kingshighway
Paragould, AR 72450-4197

900 W Kingshighway
Paragould, AR 72450-5942

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Methodist Hospital Corporation Family Medicine CurrentSince Apr 1, 2023 Accepting new patients
Fonticiella Medical Clinic, Inc Specialist CurrentSince Jul 1, 2005 Accepting new patients
Arkansas Methodist Hospital Corporation Past Accepting new patients
Ammc Physician Services, Inc Past Accepting new patients
Hospital Care Consultants of Paragould LLC Internal Medicine Past Accepting new patients

Locations

1 Medical Dr
Ste 501
Paragould, AR 72450
Phone (870) 236-6930

1000 W Kingshighway
Ste 14
Paragould, AR 72450
Phone (870) 239-7103

1000 W Kingshwy
Ste 12
Paragould, AR 72450
Phone (870) 215-5424

900 W Kingshighway
Paragould, AR 72450
Phone (870) 239-7000

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584662400000",
    "number": "1922088269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W KINGSHIGHWAY",
            "address_2": "SUITE 12",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724504141",
            "telephone_number": "870-236-6930",
            "fax_number": "870-239-8065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WEST KINGSHIGHWAY",
            "address_2": "SUITE 12",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724508894",
            "telephone_number": "870-236-6930",
            "fax_number": "870-239-8065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTICIELLA",
        "first_name": "ADALBERTO",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "C-6766",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "C-6766",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157456002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paragould, AR

Sources for this page

Verify at the official NPI Registry.