Individual provider Active NPI

Shawn L Brummett, MD

  • Family Medicine Physician
  • Bentonville, AR
National Provider Identifier
1477940971
Registry record updated Jul 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E10255 Issued in 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
Last updated
Jul 13, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E10255 AR Primary

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

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
I20171228000397 AR Practitioner - Family PracticePractitioner - Emergency MedicinePractitioner - Obstetrics/Gynecology 2567778095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4100 SW I St
Suite 200
Bentonville, AR 72713-0200
Phone (479) 268-7640

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E10255ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Northwest Arkansas Communities Current Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Jul 23, 2018 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Jul 23, 2018 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

  • Direct secure messaging: sbrummett987931@directc.mercy.net

Organizations & group practices 3

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 2

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": "1429660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531440000000",
    "number": "1477940971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 SW I ST STE 200",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727120200",
            "telephone_number": "479-268-7640",
            "fax_number": "479-254-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 SW I ST STE 200",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "72712",
            "telephone_number": "479-268-7640",
            "fax_number": "479-254-2951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "311 E Matthews Ave",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724013125",
            "country_code": "US",
            "telephone_number": "870-972-0063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUMMETT",
        "first_name": "SHAWN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-22",
        "last_updated": "2018-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E10255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.