Shawn L Brummett, MD
Individual provider Active NPI Family Medicine Physician · Bentonville, AR
NPI 1477940971 · NPPES record last updated Jul 13, 2018
Key facts
- NPI
- 1477940971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E10255 (AR)
- Practice address
- 4100 SW I St Ste 200
Bentonville, AR 72712 - Phone
- (479) 268-7640
- Fax
- (479) 254-2951
- NPI assigned
- Apr 22, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Arkansas College of Medicine, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Health Northwest Arkansas Communities
Practice addresses (Care Compare)
4100 SW I St
Suite 200
Bentonville, AR 72713-0200
Phone (479) 268-7640
Hospital & facility affiliations
- Mercy Home Health
- Mercy Hospital Northwest Arkansas
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171228000397 | AR | Practitioner - Family Practice |
2567778095 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E10255 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health Northwest Arkansas Communities | Current | Accepting new patients | |
| Mercy Health Northwest Arkansas Communities | Current |
Accepting new patients | |
| Mercy Health Northwest Arkansas Communities | Current |
Accepting new patients |
Locations
3101 SE 14th St
Bentonville, AR 72712
Phone (479) 631-2100
4100 SW I St
Ste 200
Bentonville, AR 72713
Phone (479) 268-7640
Interoperability endpoints
- sbrummett987931@directc.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | E10255 | AR | Yes |
Addresses
Primary practice location
4100 SW I St Ste 200
Bentonville, AR 72712
Mailing address
4100 SW I St Ste 200
Bentonville, AR 72712-0200
Phone (479) 268-7640
Other practice location 1
311 E Matthews Ave
Jonesboro, AR 72401-3125
Phone (870) 972-0063
Other providers in Bentonville, AR
- Sara Brown
- Shelly Marie Brown
- Karen Diane Browne
- Amanda E Broyles
- Megan Bruce
- Rebbeca Bruner
- Brittany N Brunson
- Valeria Brunson
- Cody Bryan
- Rebecca C Bryan
All providers in Bentonville, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.