Active NPI
William Talley Summerlin, M.D.
- Specialist
- Bentonville, AR
National Provider Identifier
1962614305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- R3798
- Practice address
- 701 W McNelly Rd
Suite 15
Bentonville, AR 72712-9159 - Phone
- (479) 273-5020
- Fax
- (479) 273-5074
- NPI assigned
- May 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | R3798 | AR | Primary |
Addresses
Primary practice location
701 W McNelly Rd
Suite 15
Bentonville, AR 72712-9159
Mailing address
15 Devizis Dr
Bella Vista, AR 72714-3820
Phone (479) 876-5430
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R3798 | AR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962614305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 DEVIZIS DR",
"city": "BELLA VISTA",
"state": "AR",
"postal_code": "727143820",
"telephone_number": "479-876-5430",
"fax_number": "479-876-2457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 W MCNELLY RD",
"address_2": "SUITE 15",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727129159",
"telephone_number": "479-273-5020",
"fax_number": "479-273-5074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMMERLIN",
"first_name": "WILLIAM",
"middle_name": "TALLEY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AR",
"license": "R3798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bentonville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.