PURE BALANCE OF NWA PLLC
NPI 1073359931
Psychiatry & Neurology - Psychiatry in Rogers, AR
About Pure Balance Of Nwa Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PURE BALANCE OF NWA PLLC (NPI 1073359931) is a healthcare organization registered as a psychiatry in Rogers, Arkansas and active in the NPI registry since July 2024. The organization holds a CLIA Waiver certificate valid through March 23, 2027 and lists Jacob Boydstun, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Pure Balance Of Nwa Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
11Medicare enrollment records show 11 clinicians reassign Medicare billing to Pure Balance Of Nwa PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 4 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 4
Clinicians, nearest first (11)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 04D2320713
Pure Balance Of Nwa PLLC · Rogers, ARFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Pure Balance Of Nwa PLLC's NPI number?
The NPI number for Pure Balance Of Nwa PLLC is 1073359931. It was assigned to this organization in the NPPES registry on July 1, 2024.
Where is Pure Balance Of Nwa PLLC located?
Pure Balance Of Nwa PLLC is located at 3608 W Southern Hills Blvd, Rogers, AR 72758. The listed phone number is (479) 633-7052.
What is Pure Balance Of Nwa PLLC's specialty?
The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.
Is Pure Balance Of Nwa PLLC enrolled in Medicare?
Yes. Pure Balance Of Nwa PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Pure Balance Of Nwa PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 4 Medicare specialties reassign their Medicare billing to Pure Balance Of Nwa PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Clinical Social Worker (4), Nurse Practitioner (3) and Mental Health Counselor (2). Of these, 1 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Pure Balance Of Nwa PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 04D2320713) is associated with this NPI, valid through March 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Pure Balance Of Nwa PLLC was last updated on August 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Pure Balance Of Nwa Pllc · NPI 1073359931
Psychiatry organization in Rogers, Arkansas. Organization record, active in the CMS NPPES registry since July 1, 2024.
## Identity
- **NPI:** 1073359931 (Entity type: Organization)
- **Enumerated:** July 1, 2024
- **Primary specialty:** Psychiatry & Neurology - Psychiatry · taxonomy 2084P0800X
- **Organization subpart:** No
- **Authorized official:** Jacob Boydstun, OWNER
## Practice location
- **Address:** 3608 W SOUTHERN HILLS BLVD, Rogers, AR 72758-8013
- **Phone:** (479) 633-7052
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 11 clinicians in 4 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Clinical Social Worker (4), Nurse Practitioner (3), Mental Health Counselor (2); 1 practice at this address and 4 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 5, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1073359931) · Data from the CMS NPPES public registry.