NPIMap

Individual provider Active NPI

Jim Ed Brewer, M.D.

  • Internal Medicine Physician
  • Benton, AR
National Provider Identifier
1275599987
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E-3951 Issued in AR
Practice address
722 N Main St
Benton, AR 72015
Phone
(501) 315-0059
Fax
(501) 315-0083
NPI assigned
Apr 21, 2006
Last updated
May 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E-3951 AR
Internal Medicine Physician 207R00000X E-3951 AR Primary

Addresses

Primary practice location

722 N Main St
Benton, AR 72015

Mailing address

722 N Main St
Benton, AR 72015
Phone (501) 315-0059

Other identifiers 1

IdentifierTypeStateIssuer
154130001MedicaidAR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jim-brewer@mainstmed.e-mdsdirect.com

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
I20040607001055 AR Practitioner - Internal MedicinePractitioner - Pediatric Medicine 8426030966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Arkansas College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Street Medical Clinic, P.a.Group PAC ID 6103973292, 2 clinicians

Practice addresses (Care Compare)

722 N Main St
Benton, AR 72015-3337
Phone (501) 315-0059

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-3951ARMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Main Street Medical Clinic, P.a. Internal Medicine CurrentSince Feb 1, 2009 Accepting new patients
Saline Physician Services, LLC Internal Medicine Past Accepting new patients
Ozarks Medical Center Past Accepting new patients
St Marys Physician Services, LLC Past Accepting new patients

Locations

722 N Main St
Benton, AR 72015
Phone (501) 315-0059

Interoperability endpoints

  • Direct secure messaging: jimbrewer-mmmsmc@direct.medalliesmail.com

Organizations & group practices 4

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 4

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": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1275599987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 N MAIN ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "72015",
            "telephone_number": "501-315-0059",
            "fax_number": "501-315-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 N MAIN ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "72015",
            "telephone_number": "501-315-0059",
            "fax_number": "501-315-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREWER",
        "first_name": "JIM",
        "middle_name": "ED",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-3951",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-3951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154130001",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jim-brewer@mainstmed.e-mdsdirect.com",
            "affiliation": "N",
            "address_1": "722 N Main St",
            "city": "Benton",
            "state": "AR",
            "country_code": "US",
            "postal_code": "72015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

Verify at the official NPI Registry.