Broderick Eaton, DO
Individual provider Active NPI Family Medicine Physician · Wynne, AR
NPI 1992115646 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1992115646
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E-9395 (AR)
- Practice address
- 601 Julia Ave E
Wynne, AR 72396-3506 - Phone
- (870) 238-0377
- NPI assigned
- May 3, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Owned or controlled facilities with NPI records 95
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- William Carey University College of Osteopathic Medicine, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Arcare
Practice addresses (Care Compare)
125 S 20TH St
Paducah, KY 42001-7100
Phone (270) 415-0467
2173 S Lamar Blvd
Oxford, MS 38655-5223
Phone (870) 347-3314
601 Julia E Ave
Arcare 60
Wynne, AR 72396-3506
Phone (870) 238-0377
Hospital & facility affiliations
- Legacy Hospice, Inc
- Crossridge Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in AR, MS, KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 95
| Facility | Type | Role | Since |
|---|---|---|---|
| Arcare 85 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 55 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 35 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 65 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 75 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 10 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 70 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 20 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 30 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 90 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 60 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 50 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 16 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 80 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 25 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 40 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 22 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 93 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare21 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 24 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 26 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 29 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 41 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 100 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare 43 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 46 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 47 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare 44 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 42 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 48 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 23 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 45 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentucky Care 112 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 88 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 89 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 59 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare63 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 87 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Mississippicare 113 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare64 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare120 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare111 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare128 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 121 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 31 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare32 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare131 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Mississippicare129 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare136 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare135 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare102 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare124 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare33 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare51 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare69 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare28 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare78 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare105 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare49 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare79 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Kentuckycare 151 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare150 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare138 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare153 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 137 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare141 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare142 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare39 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Mississippicare127 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare74 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare37 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Mississippicare126 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare73 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare76 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare57 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare38 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Kentuckycare58 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare91 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare86 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare92 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare96 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare83 |
Federally qualified health center | Corporate Director | Jan 1, 2024 |
| Arcare 72 |
Federally qualified health center | Corporate Director | Dec 1, 2007 |
| Arcare99 |
Federally qualified health center | Corporate Director | Dec 1, 2007 |
| Arcare159 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Arcare160 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Arcare132 |
Federally qualified health center | Corporate Officer | Dec 1, 2007 |
| Arcare98 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Arcare155 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Arcare149 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Arcare163 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Arcare162 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Arcare156 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Arcare97 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
| Arcare166 |
Federally qualified health center | Corporate Officer | Jul 8, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160525000788 | AR | Practitioner - Family Practice | 4587978259 | Reassigns benefits to 2 organizations |
| I20210209000625 | MS | Practitioner - Family Practice | 4587978259 | Reassigns benefits to 1 organization |
| I20221018003632 | KY | Practitioner - Family Practice | 4587978259 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-9395 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arcare | Current |
Accepting new patients | |
| Arcare | Current |
Accepting new patients | |
| Arcare | Current |
Accepting new patients | |
| Arcare | Current |
Accepting new patients | |
| Arcare | Past | Accepting new patients |
Locations
623 N 9th St
#40
Augusta, AR 72006
117 S 2nd St
Augusta, AR 72006
305 Falls Blvd S
Wynne, AR 72396
Phone (870) 362-3218
601 Julia Ave E
Wynne, AR 72396
Phone (870) 215-0427
601 Julia Ave E
#60
Wynne, AR 72396
Phone (870) 238-0377
125 S 20th St
Paducah, KY 42001
Phone (270) 415-0467
2173 S Lamar Blvd
Oxford, MS 38655
Phone (662) 234-3610
353 Highway 15 N
Pontotoc, MS 38863
Phone (662) 489-5999
Interoperability endpoints
- brody.eaton@arcare.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | E-9395 | AR | Yes |
Addresses
Primary practice location
601 Julia Ave E
Wynne, AR 72396-3506
Mailing address
PO Box 497
Augusta, AR 72006-0497
Phone (870) 347-3475
Other practice location 1
223 E Jackson Ave
Jonesboro, AR 72401-3119
Phone (870) 972-0063
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 214324003 | Medicaid | AR |
Other providers in Wynne, AR
- Cameron Mitchell Duke
- Ashley Duncan
- Hannah Eans
- Cynthia R Easley
- Anna Lilly Eaton
- William David Eidt
- Lisa Ellis
- Kristina R Eppes
- Evergreene Properties of North Carolina, LLC
- Lisa G Fancher
All providers in Wynne, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.