NPIMap

Individual provider Active NPI

Samuel Eugene Bledsoe, M.D.

  • Surgery Physician
  • Little Rock, AR
National Provider Identifier
1033367446
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
E10172 Issued in AR
Practice address
7 Shackleford West Blvd
Little Rock, AR 72211
Phone
(501) 664-5860
Fax
(501) 687-6342
NPI assigned
Aug 28, 2008
Last updated
Jan 9, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 26885 AL
Surgery Physician 208600000X E10172 AR Primary

Addresses

Primary practice location

7 Shackleford West Blvd
Little Rock, AR 72211

Mailing address

7 Shackleford West Blvd
Little Rock, AR 72211-3886
Phone (501) 664-5860

Other practice location 1

3311 Prescott Rd
Suite 201
Alexandria, LA 71301-3900
Phone (318) 442-6767 ext. 349

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170216001804 AR Practitioner - General Surgery 7911052758 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Heart Hospital LLCGroup PAC ID 6002838653, 85 clinicians

Practice addresses (Care Compare)

7 Shackleford W Blvd
Little Rock, AR 72211-3886
Phone (501) 664-5860

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy24
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux62
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26885ALMDSpecialist
E10172ARMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Marys Physician Services, LLC CurrentSince Nov 1, 2024 Accepting new patients
St Mary's Physician Services LLC CurrentSince Nov 1, 2024 Accepting new patients
Arkansas Heart Hospital Rural Health Services, LLC CurrentSince Jan 1, 2017 Accepting new patients
Arkansas Heart Hospital, LLC CurrentSince Jan 1, 2017 Accepting new patients
Arkansas Heart Hospital, LLC CurrentSince Jan 1, 2017 Accepting new patients
St Marys Physician Services, LLC Past Accepting new patients

Locations

1901 Encore Way
Bryant, AR 72019
Phone (501) 213-4500

1701 S Shackleford Rd
Little Rock, AR 72211
Phone (501) 219-7000

7 Shackleford West Blvd
Little Rock, AR 72211
Phone (501) 614-3671

101 Skyline Dr
Russellville, AR 72801
Phone (479) 968-2345

Organizations & group practices 6

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546992000000",
    "number": "1033367446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 SHACKLEFORD WEST BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113886",
            "telephone_number": "501-664-5860",
            "fax_number": "501-687-6342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 SHACKLEFORD WEST BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72211",
            "telephone_number": "501-664-5860",
            "fax_number": "501-687-6342"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3311 Prescott Rd",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "LA",
            "postal_code": "713013900",
            "country_code": "US",
            "telephone_number": "318-442-6767 x349",
            "fax_number": "318-441-1359",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLEDSOE",
        "first_name": "SAMUEL",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-28",
        "last_updated": "2019-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "26885",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E10172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.