NPIMap

Individual provider Active NPI

Clinton Brough Edwards, MD

  • Nephrology Physician
  • Jonesboro, AR
National Provider Identifier
1386611598
Registry record updated Apr 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
E4439 Issued in AR
Practice address
300 Carson St
Jonesboro, AR 72401-3104
Phone
(870) 932-1198
Fax
(970) 910-7709
NPI assigned
Mar 7, 2006
Last updated
Apr 28, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X E4439 AR Primary

Addresses

Primary practice location

300 Carson St
Jonesboro, AR 72401-3104

Mailing address

300 Carson St
Jonesboro, AR 72401-3104
Phone (870) 932-1198

Other identifiers 1

IdentifierTypeStateIssuer
157205001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050702000004 AR Practitioner - Nephrology 0547206211 Reassigns benefits to 1 organization
I20130501000627 MO Practitioner - NephrologyPractitioner - Internal Medicine 0547206211 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of Arkansas College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Bernards Physician Clinics IncGroup PAC ID 7012311269, shared by 3 NPIs, 211 clinicians

Practice addresses (Care Compare)

1207 State Route VV
Kennett, MO 63857-3823
Phone (573) 888-0222

300 Carson St
Jonesboro, AR 72401-3104
Phone (870) 932-1198

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E4439ARMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Bernards Physician Clinics Inc CurrentSince Jan 1, 2023 Accepting new patients
St Bernards Physician Clinics, Inc. CurrentSince Jan 1, 2023 Accepting new patients
St Bernards Physician Clinics Inc Current Accepting new patients
St Bernards Physician Clinics Inc CurrentSince Jan 1, 2023 Accepting new patients
Renal Treatment Centers-Illinois Inc PastSince Nov 17, 2019 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

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

1007 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 336-0472

1207 State Route VV
Kennett, MO 63857
Phone (573) 888-0222

1207 State Route VV
#V
Kennett, MO 63857
Phone (573) 888-0222

1312 1st St
Kennett, MO 63857
Phone (573) 559-2780

Interoperability endpoints

  • Direct secure messaging: cbedwards@sbpc.medalliesdirect.net

Organizations & group practices 6

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 25

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1386611598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104",
            "telephone_number": "870-932-1198",
            "fax_number": "970-910-7709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104",
            "telephone_number": "870-932-1198",
            "fax_number": "970-910-7709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "CLINTON",
        "middle_name": "BROUGH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-07",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AR",
            "license": "E4439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157205001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.