Individual provider Active NPI

Caitlin Brennan Wellborn, MD

  • Emergency Medicine Physician
  • Little Rock, AR
National Provider Identifier
1134780711
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
E-16483 Issued in AR
Practice address
2 Saint Vincent Cir
Little Rock, AR 72205-5423
Phone
(501) 552-3000
NPI assigned
Jun 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2019021248 MO
Emergency Medicine Physician 207P00000X E-16483 AR Primary

Addresses

Primary practice location

2 Saint Vincent Cir
Little Rock, AR 72205-5423

Mailing address

2 Saint Vincent Cir
Little Rock, AR 72205-5423

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230629003906 AR Practitioner - Emergency Medicine 7911233127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Arkansas College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shiloh Emergency Group PLLCGroup PAC ID 6901228154, 59 clinicians

Practice addresses (Care Compare)

2 Saint Vincent Cir
Little Rock, AR 72205-5423
Phone (501) 552-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-16483ARMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shiloh Emergency Group PLLC Emergency Medicine CurrentSince May 16, 2023 Accepting new patients
Washington University Physicians in Illinois, Inc Past Accepting new patients

Locations

2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680

2215 Wildwood Ave
Sherwood, AR 72120
Phone (501) 522-7100

Organizations & group practices 2

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": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1134780711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 SAINT VINCENT CIR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SAINT VINCENT CIR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055423",
            "telephone_number": "501-552-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLBORN",
        "first_name": "CAITLIN",
        "middle_name": "BRENNAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-25",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2019021248",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E-16483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.