NPIMap

Individual provider Active NPI

Jeffrey Stidman, MD

  • Gastroenterology Physician
  • Jonesboro, AR
National Provider Identifier
1205822616
Registry record updated Apr 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
C7542 Issued in AR
Practice address
300 Carson St
Jonesboro, AR 72401-3104
Phone
(870) 932-4462
Fax
(870) 910-7744
NPI assigned
Sep 21, 2005
Last updated
Apr 28, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X C7542 AR Primary

Addresses

Primary practice location

300 Carson St
Jonesboro, AR 72401-3104

Mailing address

300 Carson St
Jonesboro, AR 72401-3104
Phone (870) 932-4462

Other identifiers 1

IdentifierTypeStateIssuer
122508001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100802001050 AR Practitioner - Gastroenterology 5496784589 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Bernards Physician Clinics IncGroup PAC ID 7012311269, 211 clinicians

Practice addresses (Care Compare)

1007 E Matthews Ave
Jonesboro, AR 72401-4308
Phone (870) 336-0472

228 Bucher Dr
Mountain Home, AR 72653-3400
Phone (870) 425-4416

624 Hospital Dr
Mountain Home, AR 72653-2955
Phone (870) 508-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy191
Upper gastrointestinal (GI) endoscopy for acid reflux301

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C7542ARMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baxter County Regional Hospital Inc Current Accepting new patients
Baxter County Regional Hospital, Inc CurrentSince Jun 19, 2020 Accepting new patients
St Bernards Physician Clinics Inc CurrentSince Jan 1, 2023 Accepting new patients
Baxter County Regional Hospital Inc Gastroenterology CurrentSince Jun 19, 2020 Accepting new patients
St Bernards Physician Clinics Inc CurrentSince Jan 1, 2023 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1005 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 935-1242

1007 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 336-0472

1100 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 935-8500

228 Bucher Dr
Mountain Home, AR 72653
Phone (870) 425-4416

624 Hospital Dr
Mountain Home, AR 72653
Phone (870) 424-1000

Interoperability endpoints

  • Direct secure messaging: jstidman@sbpc.medalliesdirect.net

Organizations & group practices 6

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

Hospital & facility affiliations 5

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": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1205822616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104",
            "telephone_number": "870-932-4462",
            "fax_number": "870-910-7744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104",
            "telephone_number": "870-932-4462",
            "fax_number": "870-910-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIDMAN",
        "first_name": "JEFFREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": "C7542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122508001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.