NPIMap

Individual provider Active NPI

Mark Standridge Bradshaw, M.D.

  • Family Medicine Physician
  • Wynne, AR
National Provider Identifier
1346355518
Registry record updated Mar 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-4753 Issued in AR
Practice address
710 Falls Blvd S
Wynne, AR 72396-3514
Phone
(870) 238-2321
Fax
(870) 238-0114
NPI assigned
Aug 20, 2006
Last updated
Mar 29, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E-4753 AR Primary

Addresses

Primary practice location

710 Falls Blvd S
Wynne, AR 72396-3514

Mailing address

PO Box 158
Wynne, AR 72396-0158
Phone (870) 238-2321

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
I20070102000161 AR Practitioner - Family Practice 0143220996 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Bernards Physician Clinics IncGroup PAC ID 7012311269, 211 clinicians

Practice addresses (Care Compare)

710 Falls Blvd S
Wynne, AR 72396-3514
Phone (870) 238-2321

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions42
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-4753ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Bernards Physician Clinics, Inc. CurrentSince Jun 20, 2022 Accepting new patients
St Bernards Physician Clinics Inc Current Accepting new patients
St Bernards Physician Clinics Inc CurrentSince Jun 20, 2022 Accepting new patients
Wynne Medical Clinic Family Medicine Past Accepting new patients

Locations

1001 W Parker Rd
Jonesboro, AR 72404
Phone (870) 336-1700

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

333 Red Wolf Blvd
Jonesboro, AR 72405
Phone (870) 207-0405

310 Falls Blvd S
Wynne, AR 72396
Phone (870) 208-2151

710 Falls Blvd S
Wynne, AR 72396
Phone (870) 238-2321

Interoperability endpoints

  • Direct secure messaging: markbradshaw@sbpc.medalliesdirect.net
  • Direct secure messaging: stanbradshaw@sbpc.medalliesdirect.net

Organizations & group practices 5

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 7

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332979200000",
    "number": "1346355518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723960158",
            "telephone_number": "870-238-2321",
            "fax_number": "870-238-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 FALLS BLVD S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963514",
            "telephone_number": "870-238-2321",
            "fax_number": "870-238-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "MARK",
        "middle_name": "STANDRIDGE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2012-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-4753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynne, AR

Sources for this page

Verify at the official NPI Registry.