Individual provider Active NPI

Stephanie Michelle Pereira, M.D.

  • Emergency Medicine Physician
  • Fayetteville, AR
National Provider Identifier
1962727016
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
E-8016 Issued in AR
Practice address
3215 N. North Hills Blvd.
Fayetteville, AR 72703
Phone
(479) 463-7102
Fax
(479) 463-5987
NPI assigned
Apr 1, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X E-8016 AR Primary

Addresses

Primary practice location

3215 N. North Hills Blvd.
Fayetteville, AR 72703

Mailing address

PO Box 550
Lowell, AR 72745-0550
Phone (479) 463-7775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, AL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130726000108 AR Practitioner - Emergency Medicine 6103067632 Reassigns benefits to 1 organization
I20140925001014 AL Practitioner - Emergency Medicine 6103067632

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-8016ARMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System CurrentSince Aug 1, 2020 Accepting new patients
Washington Regional Medical System Current Accepting new patients
Washington Regional Medical System CurrentSince Aug 1, 2020 Accepting new patients
Washington Regional Medical System Past Accepting new patients

Locations

114 E Sunbridge Dr
Fayetteville, AR 72703
Phone (479) 463-2597

3215 N Northhills Blvd
Fayetteville, AR 72703
Phone (479) 463-1000

Interoperability endpoints

  • Direct secure messaging: spereira37383@washingtonregional.direct-ci.com

Organizations & group practices 4

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": "1270080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1962727016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727450550",
            "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": "3215 N. NORTH HILLS BLVD.",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-463-7102",
            "fax_number": "479-463-5987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREIRA",
        "first_name": "STEPHANIE",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-01",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E-8016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.