Shannon Petrus Zehtaban, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

E-16971 Issued in AR

Practice address

9500 Kanis Rd Ste 501
Little Rock, AR 72205-6389

Phone

(501) 227-9080

Fax

(501) 227-0410

NPI assigned

Apr 3, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shannon Nicole Petrus Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Arkansas College of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Medical Center-Little Rock Hospital, Little Rock, AR, CCN 040114
• Baptist Health Extended Care Hospital-LR Inc Long-term care hospital, Little Rock, AR, CCN 042012

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: spetrus392806@direct.baptist-healthar.org

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.

• Arkansas Health Group

  • Surgery Physician
  • Little Rock, AR
  • NPI 1760024459
  Medicare reassignment Care Compare group

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

• Baptist Health

  • General Acute Care Hospital
  • Little Rock, AR
  • NPI 1043240682
  Care Compare affiliation
• Baptist Health Extended Care Hospital - Little Rock, Inc.

  • Long Term Care Hospital
  • Little Rock, AR
  • NPI 1447439708

  Long-term care hospital

  Care Compare affiliation

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1124524699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 KANIS RD STE 501",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056389",
            "telephone_number": "501-227-9080",
            "fax_number": "501-227-0410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 KANIS RD STE 501",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056389",
            "telephone_number": "501-227-9080",
            "fax_number": "501-227-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEHTABAN",
        "first_name": "SHANNON",
        "middle_name": "PETRUS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-03",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E-16971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "PETRUS",
            "middle_name": "NICOLE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Patricia F Zarruk, DDS
• Zawada Infusion Center PLLC
• Natalya Zeagler, PA-C
• Crystal Dawn Zehm, LMSW
• Jahon Thomas Zehtaban, DDS
• Katherine Zeiger
• Shelly Ann Zellner, CTRS
• Razvan Zemianschi, MD
• Sena Zengin, MD
• Virginia Shelby Zeno, APRN

• Surgery Physician in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.