Active NPI
John N Gillespie, MD
- Ophthalmology Physician
- Russellville, AR
National Provider Identifier
1366484479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- E2388
- Practice address
- 2711 E Parkway Dr
Russellville, AR 72802-2006 - Phone
- (479) 968-7302
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | E2388 | AR | Primary |
Addresses
Primary practice location
2711 E Parkway Dr
Russellville, AR 72802-2006
Mailing address
1235 Cambridge Rd
Benton, AR 72019-2378
Phone (501) 765-8813
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 138820001 | Medicaid | AR | |
| 180046096 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E2388 | AR | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560297600000",
"number": "1366484479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 CAMBRIDGE RD",
"city": "BENTON",
"state": "AR",
"postal_code": "720192378",
"telephone_number": "501-765-8813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2711 E PARKWAY DR",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728022006",
"telephone_number": "479-968-7302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLESPIE",
"first_name": "JOHN",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2019-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "AR",
"license": "E2388",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "138820001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "180046096",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.