NPIMap

Individual provider Active NPI

Granville Leroy Vaughan III, M.D.

  • Family Medicine Physician
  • Heber Springs, AR
National Provider Identifier
1972582534
Registry record updated Nov 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C7548 Issued in AR
Practice address
2225 Highway 110 W
Heber Springs, AR 72543-3404
Phone
(501) 326-0048
Fax
(501) 362-8815
NPI assigned
Jan 12, 2006
Last updated
Nov 30, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C7548 AR Primary

Addresses

Primary practice location

2225 Highway 110 W
Heber Springs, AR 72543-3404

Mailing address

PO Box 1018
2225 Highway 110 West
Heber Springs, AR 72543-1018
Phone (501) 362-0048

Other identifiers 2

IdentifierTypeStateIssuer
51311OtherARMEDICARE INDIVIDUAL NUMBER
149045002MedicaidAR

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
I20101130000790 AR Practitioner - Family Practice 4284820457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2225 Hwy 110 W
Heber Springs, AR 72543-3404
Phone (501) 362-0048

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions85
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C7548ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medical Care, PA Family Medicine CurrentSince May 10, 1999 Accepting new patients

Locations

2225 Highway 110 W
Heber Springs, AR 72543
Phone (501) 326-0048

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259539200000",
    "number": "1972582534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1018",
            "address_2": "2225 HIGHWAY 110 WEST",
            "city": "HEBER SPRINGS",
            "state": "AR",
            "postal_code": "725431018",
            "telephone_number": "501-362-0048",
            "fax_number": "501-362-8815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 HIGHWAY 110 W",
            "city": "HEBER SPRINGS",
            "state": "AR",
            "postal_code": "725433404",
            "telephone_number": "501-326-0048",
            "fax_number": "501-362-8815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "GRANVILLE",
        "middle_name": "LEROY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2009-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C7548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL NUMBER",
            "identifier": "51311",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149045002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Heber Springs, AR

Sources for this page

Verify at the official NPI Registry.