Individual provider Active NPI

John M Rosen, MD

  • Pediatric Gastroenterology Physician
  • Little Rock, AR
National Provider Identifier
1407073422
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
E-13757 Issued in AR
Practice address
1 Childrens Way # 203
Little Rock, AR 72202-3500
Phone
(501) 364-3933
Fax
(501) 364-2939
NPI assigned
Apr 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E-13757 AR
Pediatric Gastroenterology Physician 2080P0206X 0436401 KS
Pediatric Gastroenterology Physician 2080P0206X 2013014796 MO
Pediatric Gastroenterology Physician 2080P0206X E-13757 AR Primary

Addresses

Primary practice location

1 Childrens Way # 203
Little Rock, AR 72202-3500

Mailing address

1 Childrens Way # 653
Little Rock, AR 72202-3500
Phone (501) 364-1100

Other practice location 1

2401 Gillham Rd
Kansas City, MO 64108-4619
Phone (816) 983-6926

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
I20240404000770 AR Practitioner - Pediatric Medicine 9234284332 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-13757ARMDPediatric Gastroenterology Physician
0436401KSMDPediatric Gastroenterology Physician
2013014796MOMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Children'S Hospital CurrentSince Apr 1, 2024 Accepting new patients
Arkansas Childrens Professional Services Organization LLC Pediatrics CurrentSince Jul 21, 2025 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Apr 1, 2024 Accepting new patients
University of Arkansas for Medical Sciences Pediatrics Current Accepting new patients
Arkansas Childrens Hospital Pediatrics CurrentSince Apr 1, 2024 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Apr 1, 2024 Accepting new patients
Arkansas Childrens Northwest, Inc. Past Accepting new patients

Locations

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

1 Childrens Way
Little Rock, AR 72202
Phone (501) 364-1874

1 Childrens Way
#203
Little Rock, AR 72202
Phone (501) 364-2180

1 Childrens Way
#653
Little Rock, AR 72202
Phone (501) 614-2006

1 Childrens Way
Ste 653
Little Rock, AR 72202

Interoperability endpoints

  • FHIR API: https://epicproxy.et1036.epichosted.com/APIProxyPRD/AC/api/FHIR/R4
  • Direct secure messaging: jrosen281275@direct.kuha.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1407073422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 653",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-1100",
            "fax_number": "501-364-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 203",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-3933",
            "fax_number": "501-364-2939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2401 Gillham Rd",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641084619",
            "country_code": "US",
            "telephone_number": "816-983-6926",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSEN",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-13757",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "KS",
            "license": "0436401",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "MO",
            "license": "2013014796",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "AR",
            "license": "E-13757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.