Active NPI
Jimmy Norman III
- Counselor
- Clinton, AR
National Provider Identifier
1275070500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- A2011156
- Practice address
- 242 Shake Rag Rd
Clinton, AR 72031-6629 - Phone
- (501) 303-3105
- NPI assigned
- Jan 25, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | A2011156 | AR | Primary |
Addresses
Primary practice location
242 Shake Rag Rd
Clinton, AR 72031-6629
Mailing address
PO Box 1589
Benton, AR 72018-1589
Phone (501) 303-3105
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A2011156 | AR | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conway County Community Service Inc. | 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.
-
- Community/Behavioral Health Agency
- Morrilton, AR
- NPI 1770631467
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706659200000",
"number": "1275070500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1589",
"city": "BENTON",
"state": "AR",
"postal_code": "720181589",
"telephone_number": "501-303-3105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "242 SHAKE RAG RD",
"city": "CLINTON",
"state": "AR",
"postal_code": "720316629",
"telephone_number": "501-303-3105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORMAN III",
"first_name": "JIMMY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-01-25",
"last_updated": "2024-01-31",
"certification_date": "2024-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AR",
"license": "A2011156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.