Mark Standridge Bradshaw, M.D.
Individual provider Active NPI Family Medicine Physician · Wynne, AR
NPI 1346355518 · NPPES record last updated Mar 29, 2012
Key facts
- NPI
- 1346355518
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E-4753 (AR)
- Practice address
- 710 Falls Blvd S
Wynne, AR 72396-3514 - Phone
- (870) 238-2321
- Fax
- (870) 238-0114
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 7
Medicare Care Compare profile
- 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 Inc
Practice addresses (Care Compare)
710 Falls Blvd S
Wynne, AR 72396-3514
Phone (870) 238-2321
Hospital & facility affiliations
- Crossridge Comm Hospital Home Health
- Elite Home Health
- Crossridge Community Hospital
- St Bernards Medical Center
- Baptist Memorial Hospital Jonesboro, Inc.
- Forrest City Medical Center
- Crossridge Community Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 42 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070102000161 | AR | Practitioner - Family Practice | 0143220996 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-4753 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Bernards Physician Clinics, Inc. | Current |
Accepting new patients | |
| St Bernards Physician Clinics Inc | Current | Accepting new patients | |
| St Bernards Physician Clinics Inc | Current |
Accepting new patients | |
| Wynne Medical Clinic | Family Medicine | Past | Accepting new patients |
Locations
1005 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 935-1242
333 Red Wolf Blvd
Jonesboro, AR 72405
Phone (870) 933-1823
1001 W Parker Rd
Jonesboro, AR 72404
Phone (870) 336-1700
710 Falls Blvd S
Wynne, AR 72396
Phone (870) 238-2321
310 Falls Blvd S
Wynne, AR 72396
Phone (870) 208-2151
Interoperability endpoints
- markbradshaw@sbpc.medalliesdirect.net
- stanbradshaw@sbpc.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | E-4753 | AR | Yes |
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
Other providers in Wynne, AR
- Leah M Boone
- Jessie Bouland
- Asia Corrine Boykin
- Tabatha Bradley
- Elizabeth Pleasants Bradshaw
- Paige Alison Branham
- Brawner Counseling, LLC
- Elizabeth A Brawner
- Kurt W Brawner
- Leann Brawner
All providers in Wynne, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.