NPIMap

Organization Active NPI

Jack Stephens Heart Institute LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Little Rock, AR
National Provider Identifier
1033404199
Registry record updated Feb 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
JACK STEPHENS HEART INSTITUTE LLC
Practice address
5 St. Vincent Circle
Ste 501
Little Rock, AR 72205-5414
Phone
(501) 666-2894
Fax
(501) 666-9017
NPI assigned
Jun 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2012

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

Authorized official

Name
Mr. Peter Banko
Title
Ceo/President
Phone
(501) 552-3922

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X AR Primary

Addresses

Primary practice location

5 St. Vincent Circle
Ste 501
Little Rock, AR 72205-5414

Mailing address

5 St. Vincent Circle
Ste 501
Little Rock, AR 72205-5414
Phone (501) 666-2894

Other names 1

  • St. Vincent Cardiovascular Surgeons Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110915000739 AR Part B Supplier - Clinic/Group Practice 1355512708 Receives reassigned benefits from 10 practitioners
Practice locations: Little Rock, AR

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

5 Saint Vincent Cir
Ste 501
Little Rock, AR 72205
Phone (501) 666-2894

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1033404199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 ST. VINCENT CIRCLE",
            "address_2": "STE 501",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055414",
            "telephone_number": "501-666-2894",
            "fax_number": "501-666-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 ST. VINCENT CIRCLE",
            "address_2": "STE 501",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055414",
            "telephone_number": "501-666-2894",
            "fax_number": "501-666-9017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK STEPHENS HEART INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-16",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "BANKO",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "501-552-3922",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Vincent Cardiovascular Surgeons",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.