Cheryl Premila Speake, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

E-9186 Issued in AR

Practice address

3224 S 70TH St
Fort Smith, AR 72903-5050

Phone

(479) 314-4810

Fax

(479) 314-4829

NPI assigned

Apr 15, 2010

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 5

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cspeake723160@directb.mercy.net

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.

• Mercy Clinic Fort Smith Communities

  • Multi-Specialty Clinic/Center
  • Fort Smith, AR
  • NPI 1902073620
  Medicare reassignment NPD
• Mercy Clinic Fort Smith Communities

  • Endocrinology, Diabetes & Metabolism Physician
  • Fort Smith, AR
  • NPI 1790258002
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1295051167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 S 74TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035156",
            "telephone_number": "479-314-1101",
            "fax_number": "479-314-4704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3224 S 70TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035050",
            "telephone_number": "479-314-4810",
            "fax_number": "479-314-4829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPEAKE",
        "first_name": "CHERYL",
        "middle_name": "PREMILA",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "BP10037147",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-9186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN MEDICAL LIC",
            "identifier": "2487",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q001054",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID SOONERCARE",
            "identifier": "200601840A",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200601840A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209981003",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sparks Regional Medical Center (Cancer Center)
• Sparks Regional Medical Center
• Jessica Sparks, CIT
• Jordan Sparrow
• Tracie Lynn Spaulding
• Joseph Lee Speake, D.O.
• Kenneth Spears
• Spectrum Connections LLC
• Speech Haus LLC
• Speech Language Pathology Services, Inc (holloway speech pathology)

• Pediatrics Physician in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Pediatrics Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.