NPIMap

Organization Active NPI

Mission Family Practice PLLC

Doing business as Mission Family Practice

  • Family Medicine Physician
  • Fayetteville, AR
National Provider Identifier
1982009395
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C-7247 Issued in AR
Legal business name
MISSION FAMILY PRACTICE PLLC
Doing business as
Mission Family Practice
Practice address
2744 E Millennium Dr Ste 1
Fayetteville, AR 72703-4710
Phone
(479) 571-6000
Fax
(479) 571-3344
NPI assigned
Oct 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2026

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

Authorized official

Name
Mark A Bonner, MDNPI 1437188869
Title
Physician
Phone
(479) 571-6000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X C-7247 AR Primary

Addresses

Primary practice location

2744 E Millennium Dr Ste 1
Fayetteville, AR 72703-4710

Mailing address

PO Box 3678
Fayetteville, AR 72702-3678
Phone (479) 571-6000

Other identifiers 4

IdentifierTypeStateIssuer
113998001MedicaidAR
51916OtherARUNSPECIFIED
P00200111OtherARRR MCR
51916OtherARAR BC/BS

Other names 2

  • Mission Family Practice Doing business as
  • Mission Family Practice PLLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141223001222 AR Part B Supplier - Clinic/Group Practice 4587987540 Receives reassigned benefits from 9 practitioners
Practice locations: Fayetteville, AR

National Provider Directory

National Provider Directory

Locations

2630 E Citizens Dr
Ste 34
Fayetteville, AR 72703

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778716800000",
    "number": "1982009395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3678",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727023678",
            "telephone_number": "479-571-6000",
            "fax_number": "479-571-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2744 E MILLENNIUM DR STE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034710",
            "telephone_number": "479-571-6000",
            "fax_number": "479-571-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "479-571-6000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C-7247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113998001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNSPECIFIED",
            "identifier": "51916",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "P00200111",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BC/BS",
            "identifier": "51916",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mission Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mission Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mission Family Practice PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.