Individual provider Active NPI

Brent A Davis, DPT

  • Physical Therapist
  • Trumann, AR
National Provider Identifier
1982254710
Registry record updated Sep 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT4650 Issued in AR
Practice address
516 Industrial Park Access Rd
Trumann, AR 72472
Phone
(870) 483-6131
Fax
(870) 483-2573
NPI assigned
Sep 13, 2019
Last updated
Sep 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT4650 AR Primary

Addresses

Primary practice location

516 Industrial Park Access Rd
Trumann, AR 72472

Mailing address

PO Box 1960
Jonesboro, AR 72403-1960
Phone (870) 483-6131

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191024002332 AR Practitioner - Physical Therapist in Private Practice 0749512796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

516 Industrial Park Dr
Trumann, AR 72472-9602
Phone (870) 935-8388

Merit-based Incentive Payment System (MIPS)

Final score
75.65 of 100Reported as group
Quality
44.87
Promoting interoperability
100
Improvement activities
40
Cost
73.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT4650ARMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Sep 9, 2019 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Current Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Sep 9, 2019 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Past Accepting new patients

Locations

1111 Windover Rd
Jonesboro, AR 72401
Phone (870) 935-5432

909 Enterprise Dr
Jonesboro, AR 72401
Phone (870) 336-1100

516 Industrial Park Dr
Trumann, AR 72472
Phone (870) 483-6131

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

NPI Registry JSON

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

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568332800000",
    "number": "1982254710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1960",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031960",
            "telephone_number": "870-483-6131",
            "fax_number": "870-483-2573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 INDUSTRIAL PARK ACCESS RD",
            "city": "TRUMANN",
            "state": "AR",
            "postal_code": "72472",
            "telephone_number": "870-483-6131",
            "fax_number": "870-483-2573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BRENT",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-13",
        "last_updated": "2019-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT4650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumann, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.