Individual provider Active NPI

Steven D Vanderbilt, APRN

  • Family Nurse Practitioner
  • Jonesboro, AR
National Provider Identifier
1063977965
Registry record updated Feb 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A006068 Issued in AR
Practice address
2205 W Parker Rd
Jonesboro, AR 72404-7778
Phone
(870) 936-8000
Fax
(870) 936-7612
NPI assigned
Feb 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A006068 AR Primary

Addresses

Primary practice location

2205 W Parker Rd
Jonesboro, AR 72404-7778

Mailing address

PO Box 1960
Jonesboro, AR 72403-1960
Phone (870) 936-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190304001063 AR Practitioner - Nurse Practitioner 4183963432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Arkansas Clinic Charitable Foundation, Inc.Group PAC ID 2961547526, 294 clinicians

Practice addresses (Care Compare)

1111 Windover Rd
Jonesboro, AR 72401-6159
Phone (870) 935-5432

2205 W Parker Rd
Jonesboro, AR 72404-7778
Phone (870) 933-9250

3001 Apache Dr
Suite B
Jonesboro, AR 72401-7447
Phone (870) 936-8000

Hospital & facility affiliations

  • Elite Home Health Home health agency, Jonesboro, AR, CCN 047145
  • Baptist Memorial Hospital Jonesboro, Inc. Hospital, Jonesboro, AR, CCN 040118
  • St Bernards Medical Center Hospital, Jonesboro, AR, CCN 040020

Merit-based Incentive Payment System (MIPS)

Final score
75.65 of 100Reported as group
Quality
44.87
Promoting interoperability
100
Improvement activities
40
Cost
73.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Current Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Mar 1, 2019 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Mar 1, 2019 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Past Accepting new patients

Locations

2205 W Parker Rd
Jonesboro, AR 72404
Phone (870) 933-9250

1111 Windover Rd
Jonesboro, AR 72401
Phone (870) 935-5432

Interoperability endpoints

  • Direct secure messaging: svanderbilt31989@direct.bmhcc.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1063977965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1960",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031960",
            "telephone_number": "870-936-8000",
            "fax_number": "870-936-7612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 W PARKER RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724047778",
            "telephone_number": "870-936-8000",
            "fax_number": "870-936-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERBILT",
        "first_name": "STEVEN",
        "middle_name": "D",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-05",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A006068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.