NPIMap

Individual provider Active NPI

Phillip G Doerner III, D.O.

  • Hospitalist Physician
  • Fayetteville, AR
National Provider Identifier
1962864694
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
E-11424 Issued in AR
Practice address
3215 N Northhills Blvd
Fayetteville, AR 72703-4424
Phone
(479) 463-7102
Fax
(479) 463-7864
NPI assigned
Mar 22, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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 AR
Hospitalist Physician 208M00000X E-11424 AR Primary

Addresses

Primary practice location

3215 N Northhills Blvd
Fayetteville, AR 72703-4424

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
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
I20190923000239 AR Practitioner - Internal Medicine 6709178064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Oklahoma State University College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington Regional Medical System 238 clinicians

Practice addresses (Care Compare)

3215 N Northhills Blvd
Washington Regional Hospital Medicine Group
Fayetteville, AR 72703-4424
Phone (479) 463-7102

Hospital & facility affiliations

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-11424ARMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System Current Accepting new patients
Washington Regional Medical System CurrentSince Sep 1, 2019 Accepting new patients
Washington Regional Medical System Hospitalist CurrentSince Sep 1, 2019 Accepting new patients
Washington Regional Medical Center Past Accepting new patients
Washington Regional Medical System Past Accepting new patients

Locations

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

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

Interoperability endpoints

  • Direct secure messaging: pdoerner27971@washingtonregional.direct-ci.com

Organizations & group practices 15

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.

View all 15

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": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568851200000",
    "number": "1962864694",
    "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 NORTHHILLS BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034424",
            "telephone_number": "479-463-7102",
            "fax_number": "479-463-7864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOERNER",
        "first_name": "PHILLIP",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-22",
        "last_updated": "2019-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AR",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AR",
            "license": "E-11424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.