Active NPI
Jerry Douglas Byrum, MD
- Pediatrics Physician
- Little Rock, AR
National Provider Identifier
1194789685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- C6800
- Practice address
- 904 Autumn Rd
Suite 100
Little Rock, AR 72211-3742 - Phone
- (501) 224-5437
- Fax
- (501) 224-3473
- NPI assigned
- Apr 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | C6800 | AR | Primary |
Addresses
Primary practice location
904 Autumn Rd
Suite 100
Little Rock, AR 72211-3742
Mailing address
904 Autumn Rd
Suite 100
Little Rock, AR 72211-3742
Phone (501) 224-5437
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11282000000 | Other | AR | QUALCHOICE |
| 114501001 | Medicaid | AR | |
| 4208764 | Other | AR | AETNA |
| 516264 | Other | AR | HEALTHLINK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C6800 | AR | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arkansas Health Group | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Preferred Provider Organization
- Little Rock, AR
- NPI 1235192980
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320278400000",
"number": "1194789685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "904 AUTUMN RD",
"address_2": "SUITE 100",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722113742",
"telephone_number": "501-224-5437",
"fax_number": "501-224-3473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 AUTUMN RD",
"address_2": "SUITE 100",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722113742",
"telephone_number": "501-224-5437",
"fax_number": "501-224-3473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BYRUM",
"first_name": "JERRY",
"middle_name": "DOUGLAS",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-13",
"last_updated": "2011-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AR",
"license": "C6800",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALCHOICE",
"identifier": "11282000000",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114501001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4208764",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "516264",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}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 Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.