NPIMap

Organization Active NPI

Sparkfit Community Inc

  • Professional Counselor
  • Little Rock, AR
National Provider Identifier
1417511387
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
SPARKFIT COMMUNITY INC
Practice address
1202 Main St Ste 204
Little Rock, AR 72202-5057
Phone
(501) 428-3217
NPI assigned
Apr 26, 2019
Last updated
Aug 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Glenn McCracken, LPCNPI 1114222932
Title
Owner
Phone
(501) 428-3217

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

1202 Main St Ste 204
Little Rock, AR 72202-5057

Mailing address

1324B Main St
Little Rock, AR 72202-5034
Phone (501) 400-8682

Other practice location 1

1324B Main St
Little Rock, AR 72202-5034
Phone (501) 400-8682

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240927000795 AR Part B Supplier - Clinic/Group Practice 2961933205 Receives reassigned benefits from 7 practitioners
Practice locations: N Little Rock, AR

National Provider Directory

National Provider Directory

Locations

1202 Main St
Ste 204
Little Rock, AR 72202
Phone (501) 428-3217

1324B Main St
Little Rock, AR 72202
Phone (501) 400-8682

2500 Lakeview Rd
North Little Rock, AR 72116
Phone (501) 322-3374

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1556236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1417511387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324B MAIN ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722025034",
            "telephone_number": "501-400-8682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 MAIN ST STE 204",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722025057",
            "telephone_number": "501-428-3217"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1324B Main St",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722025034",
            "country_code": "US",
            "telephone_number": "501-400-8682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPARKFIT COMMUNITY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-26",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "MCCRACKEN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-428-3217",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.