NORTHEAST ARKANSAS PAIN MEDICINE (NPI# 1235300765) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235300765 |
| Entity Type | Organization |
| Organization Name | NORTHEAST ARKANSAS PAIN MEDICINE |
| Practice Address |
505 E Matthews Ave Suite 103 Jonesboro AR 72401-3144 |
| Practice Telephone | 8709720411 |
| Practice Fax Number | 8709338011 |
| Mailing Telephone | 8709720411 |
| Mailing Fax Number | 8709338011 |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2009-12-15 |
| Authorized Official Name | MONICA R FORMON (OFFICE MANAGER) |
| Authorized Official Telephone | 8709720411 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
E1479 | AR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 143853002 | 05 | |
| AR | BLUE CROSS | 5K398 | 01 |
| Street Address |
505 E MATTHEWS AVE SUITE 103 |
| City | JONESBORO |
| State | AR |
| Zip Code | 72401-3144 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346248671 | Stephen Randolph Rauls | Obstetrics & Gynecology | 505 E Matthews Ave, Ste 203, Jonesboro, AR 72401-3144 | 2005-07-11 |
| 1548733678 | Bernice Esther Brown | Nurse Practitioner | 505 E Matthews Ave, Jonesboro, AR 72401-3144 | 2019-01-11 |
| 1184114928 | Mandy Leonard | Registered Nurse | 505 E Matthews Ave, Jonesboro, AR 72401-3144 | 2018-05-17 |
| 1881184661 | Natalie Marotti | Registered Nurse | 505 E Matthews Ave, Jonesboro, AR 72401-3144 | 2018-05-16 |
| 1447796438 | Barbara Cooley | Nurse Practitioner | 505 E Matthews Ave, Jonesboro, AR 72401-3144 | 2017-01-13 |
| 1588976021 | Elizabeth Jordon Robinson | Nurse Practitioner | 505 E Matthews Ave, Suite 303, Jonesboro, AR 72401-3144 | 2010-07-13 |
| 1821326141 | Bridget Anne Crouch | Speech-Language Pathologist | 505 E Matthews Ave, Suite 102, Jonesboro, AR 72401-3144 | 2009-11-24 |
| 1639327679 | Lara Christena Zirbel | Nurse Practitioner | 505 E Matthews Ave, Suite #301, Jonesboro, AR 72401-3144 | 2008-09-03 |
| 1477749992 | Michelle Wingo | Physician Assistant | 505 E Matthews Ave, Suite 303, Jonesboro, AR 72401-3144 | 2007-09-18 |
| 1811109796 | Denton Brothers, Inc. | Physical Therapist | 505 E Matthews Ave, Suite 205, Jonesboro, AR 72401-3144 | 2007-05-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453368 | Mariah Kay Jackson | Physical Therapy Assistant | Creative Kids Therapy, Jonesboro, AR 72401 | 2020-10-05 |
| 1821606005 | Kafayat Folake Iyanda | Specialist/Technologist | 2105 East Aggie Rd, Jonesboro, AR 72401 | 2020-07-14 |
| 1053936310 | Josh Roberts | Physical Therapist | 1010 South Main St, Jonesboro, AR 72401 | 2020-06-12 |
| 1003449687 | Amy Mary Elizabeth Daughhetee | Nurse Practitioner | 225 East Washington Ave, Jonesboro, AR 72401 | 2020-02-21 |
| 1871126698 | Sarah Lowtharp | Clinical Nurse Specialist | 225 East Washington Ave., Jonesboro, AR 72401 | 2020-02-20 |
| 1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
| 1265073704 | Michael Bruce Collie | Registered Nurse | 837 Williett Road, Jonesboro, AR 72401 | 2019-10-07 |
| 1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
| 1841843943 | Destinee Katrina Cole | Specialist/Technologist | 2015 Aggie Rd, Jonesboro, AR 72401 | 2019-07-18 |
| 1699250472 | Jessica Marie Mcnatt | Occupational Therapist | 907 County Road 753, Jonesboro, AR 72401 | 2018-09-27 |
| Find all providers in zip 72401 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699781427 | Sunil Gera | Pain Medicine | 2601 Southwest Square, Jonesboro, AR 72401 | 2006-08-01 |
| 1801976956 | Calin A Savu | Pain Medicine | 505 E Matthews Ave, Suite 103, Jonesboro, AR 72401-3144 | 2006-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662345 | Bentonville Ambulatory Surgery Center, LLC | Pain Medicine | 2902 We Mid-cities Dr, Bentonville, AR 72712 | 2020-09-08 |
| 1932619327 | Fort Neuro | Pain Medicine | 1501 S Waldron Rd Ste 109, Fort Smith, AR 72903-2568 | 2017-10-11 |
| 1891061040 | Vadim Petrov-kondratov | Pain Medicine | 180 Medical Park Pl Ste 102, Hot Springs, AR 71901-8066 | 2012-03-31 |
| 1356635486 | Mohamed Tolba | Pain Medicine | 1080 Pats Ln, Conway, AR 72032-4754 | 2011-06-06 |
| 1295032407 | Interventional Pain Specialists of Nwa, Pllc | Pain Medicine | 509 E Millsap Rd Ste 109, Fayetteville, AR 72703-4862 | 2011-02-24 |
| 1376733824 | Hot Springs Interventional Pain Management | Pain Medicine | 1 Mercy Ln Ste 304, Hot Springs, AR 71913 | 2007-07-31 |
| 1558447599 | White River Health System, Inc. | Pain Medicine | 1700 Harrison St Ste T, Batesville, AR 72501-7315 | 2006-10-31 |
| 1104806702 | Robert David Cannon | Pain Medicine | 3715 N Business Dr, Suite #101, Fayetteville, AR 72703-5204 | 2006-01-19 |
| 1386641520 | Sunder Krishnan | Pain Medicine | 14918 Cantrell Rd, Little Rock, AR 72223-4248 | 2005-07-01 |
| 1568465698 | Donald L Boos Jr. | Pain Medicine | 307 Carpenter Dam Rd Ste F, Hot Springs, AR 71901-8282 | 2005-05-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.