Individual provider Active NPI

Shane Sparks, M.D.

  • Psychiatry Physician
  • Little Rock, AR
National Provider Identifier
1306032438
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
E-6553 Issued in AR
Practice address
2 Saint Vincent Cir
Little Rock, AR 72205-5423
Phone
(501) 686-8000
NPI assigned
Sep 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X E-6553 AR Primary
Addiction Psychiatry Physician 2084P0802X E-6553 AR

Addresses

Primary practice location

2 Saint Vincent Cir
Little Rock, AR 72205-5423

Mailing address

1725 Centennial Club Dr
Conway, AR 72034-8194
Phone (501) 690-5134

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110915000056 AR Practitioner - Psychiatry 4486825874 Practice locations: Little Rock, AR

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Arkansas College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2 Saint Vincent Cir
Little Rock, AR 72205-5423
Phone (501) 552-3000

Hospital & facility affiliations

  • CHI-St Vincent Infirmary Hospital, Little Rock, AR, CCN 040007

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Physician Clinics LLC 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.

Hospital & facility affiliations 2

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": "1190332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1306032438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 CENTENNIAL CLUB DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348194",
            "telephone_number": "501-690-5134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SAINT VINCENT CIR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055423",
            "telephone_number": "501-686-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKS",
        "first_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-21",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AR",
            "license": "E-6553",
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "AR",
            "license": "E-6553",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.