Lance Faddis (NPI# 1255398400, PAC ID# 8921085630) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1255398400 |
| PAC ID by PECOS | 8921085630 |
| Professional Enrollment ID | I20040701000149 |
| Full Name | Lance Faddis |
| Organization Legal Name | MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES |
| Address |
1225 E Centerton Blvd Mercy Clinic Primary Care Centerton Centerton AR 72719-1225 |
| Phone Number | 4797951301 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE |
| Graduation Year | 2000 |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 0648177873 |
| Number of Group Practice Members | 229 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 040010 | MERCY HOSPITAL NORTHWEST ARKANSAS |
| Address | Phone | Organization |
|---|---|---|
| 1225 E Centerton Blvd, Mercy Clinic Primary Care Centerton, Centerton, AR 72719-1225 | 4797951301 | MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES |
| Organization Legal Name | MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES |
| Physicians | 250 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jaime Lynn Sather | Nurse Practitioner | Mercy Health Northwest Arkansas Communities | 515 Enterprise Dr, 300 Mercy Clinic Behavioral Health En, Lowell, AR 72745-8982 |
| Melinda S Tucker | Nurse Practitioner | Mercy Health Northwest Arkansas Communities | 701 Sw Regional Airport Blvd, Suite 1, Bentonville, AR 72712-4589 |
| Dominic Amadeo Jacobelli | Sports Medicine | Mercy Health Northwest Arkansas Communities | 1000 S 52nd St, Mercy Clinic Orthopedic Rogers, Rogers, AR 72758-8610 |
| Taylor Beauregard Kelamis | Nurse Practitioner | Mercy Health Northwest Arkansas Communities | 1110 W Robinson Ave, Mercy Clinic Family Medicine W. R, Springdale, AR 72764-6233 |
| Kali Michelle Eddy | Nurse Practitioner | Mercy Health Northwest Arkansas Communities | 2100 S 54th St, Mercy Clinic Urology S 54th S, Rogers, AR 72758-8169 |
| Megan E Busch | Family Medicine | Mercy Health Northwest Arkansas Communities | 3101 Se 14th St, Bentonville, AR 72712-4900 |
| Manikandan Rajagopal | Internal Medicine | Mercy Health Northwest Arkansas Communities | 2710 Rife Medical Lane, Rogers, AR 72758-1452 |
| Robert Thaxton Wells | Gastroenterology | Mercy Health Northwest Arkansas Communities | 1 Mercy Way, Mercy Clinic Primary Care Bella V, Bella Vista, AR 72714-3000 |
| Raja Sekhar Dondeti | Family Medicine | Mercy Health Northwest Arkansas Communities | 4100 Sw I St, 100 Mercy Clinic Pediatrics I Street, Bentonville, AR 72713-0200 |
| Terryl J Ortego | Gastroenterology | Mercy Health Northwest Arkansas Communities | 116 W Monroe Ave, Mercy Clinic Gastroenterology Mon, Lowell, AR 72745-9682 |
| Street Address |
1225 E CENTERTON BLVD MERCY CLINIC PRIMARY CARE CENTERTON |
| City | CENTERTON |
| State | AR |
| Zip | 72719-1225 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kyler Todd Offenbacker | Physical Therapy | Serc Rehabilitation Partners LLC | 1240 E Centerton Blvd, Centerton, AR 72719-1300 |
| Anne Marie Cope | Physical Therapy | 1128 E Centerton Blvd, Centerton, AR 72719-6058 | |
| Carolyn Reeves | Internal Medicine | 1415 E Centerton Blvd, Centerton, AR 72719-7050 | |
| Megan Jo Petty | Optometry | Petty and Petty, P. A. | 101 Dawn Dr, Centerton, AR 72719-9314 |
| Regan S Petty | Optometry | Petty and Petty, P. A. | 101 Dawn Dr, Centerton, AR 72719-9314 |
| Jacob Joseph Dufour | Optometry | Petty and Petty, P. A. | 101 Dawn Dr, Centerton, AR 72719-9314 |
| Randy D Conover | Family Medicine | Northwest Benton County Physician Services LLC | 101 Sun Meadow Dr, Centerton, AR 72719-9610 |
| Erin Michelle Kwyzla | Nurse Practitioner | Northwest Benton County Physician Services LLC | 101 Sun Meadow Dr, Centerton, AR 72719-9610 |
| Gregory Ryan Spears | Family Medicine | Northwest Benton County Physician Services LLC | 101 Sun Meadow Dr, Centerton, AR 72719-9610 |
| Michelle Manthe | Physician Assistant | Northwest Benton County Physician Services LLC | 101 Sun Meadow Dr, Centerton, AR 72719-9610 |
| Find all physicians in zip 72719 | |||
| City | CENTERTON |
| Zip Code | 72719 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | CENTERTON + INTERNAL MEDICINE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.