Individual provider Active NPI

Michael Jerkins, M.D.

  • Pediatrics Physician
  • Cabot, AR
National Provider Identifier
1417377334
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
E-14710 Issued in AR
Practice address
205 Westport Dr Ste 1
Cabot, AR 72023-3657
Phone
(501) 843-6585
Fax
(501) 843-2380
NPI assigned
Apr 17, 2014
Last updated
May 16, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E-14710 AR
Pediatrics Physician 208000000X E-14710 AR Primary

Addresses

Primary practice location

205 Westport Dr Ste 1
Cabot, AR 72023-3657

Mailing address

11001 Executive Center Dr Ste 200
Little Rock, AR 72211-4393
Phone (501) 955-4350

Other practice location 1

11001 Executive Center Dr Ste 200
Little Rock, AR 72211-4393
Phone (501) 955-4350

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
I20210920003211 AR Practitioner - Internal Medicine 1658597356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Practice addresses (Care Compare)

205 Westport Dr
1 Baptist Health Family Clinic Cabot
Cabot, AR 72023-3657
Phone (501) 843-6585

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-14710ARMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Health Group CurrentSince Sep 15, 2021 Accepting new patients

Locations

205 Westport Dr
Ste 1
Cabot, AR 72023
Phone (501) 843-6585

11001 Executive Center Dr
Ste 200
Little Rock, AR 72211
Phone (501) 812-7215

Interoperability endpoints

  • Direct secure messaging: mjerkins550378@direct.baptist-healthar.org

Organizations & group practices 1

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 3

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": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1417377334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DR STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114393",
            "telephone_number": "501-955-4350",
            "fax_number": "501-955-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 WESTPORT DR STE 1",
            "city": "CABOT",
            "state": "AR",
            "postal_code": "720233657",
            "telephone_number": "501-843-6585",
            "fax_number": "501-843-2380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11001 Executive Center Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722114393",
            "country_code": "US",
            "telephone_number": "501-955-4350",
            "fax_number": "501-955-4540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JERKINS",
        "first_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-17",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-14710",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-14710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cabot, AR

Sources for this page

Verify at the official NPI Registry.