Stephen C Fiedorek, M.D.

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

R3678 Issued in AR

Practice address

1525 Country Club Road
Sherwood, AR 72120-5076

Phone

(501) 758-1530

Fax

(501) 819-6171

NPI assigned

Jul 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: stephen.fiedorek.1@17087.direct.athenahealth.com

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.

• The Pediatric Clinic of NLR, P.a.

  • Medical Specialty Clinic/Center
  • Sherwood, AR
  • NPI 1588692198
  NPD (past)
• The Pediatric Clinic of NLR, P.a.

  • Medical Specialty Clinic/Center
  • Cabot, AR
  • NPI 1669146346
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1609898006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 COUNTRY CLUB ROAD",
            "city": "SHERWOOD",
            "state": "AR",
            "postal_code": "721205076",
            "telephone_number": "501-758-1530",
            "fax_number": "501-819-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 COUNTRY CLUB ROAD",
            "city": "SHERWOOD",
            "state": "AR",
            "postal_code": "721205076",
            "telephone_number": "501-758-1530",
            "fax_number": "501-819-6171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIEDOREK",
        "first_name": "STEPHEN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "AR",
            "license": "R3678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100160440A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "50644",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112344001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Savannah Leigh Fawbush
• Mackenzie Rachelle Featherston
• Steve K Fender, DC
• Lauren Elizabeth Fendley, OT
• Jennie L. Fickler, COTA/L
• Vicki Finch
• Kendl Fischer, PHARMD
• Nathaniel Floyd
• For God'S Glory, Inc
• Kristyn Fortner

• Pediatric Gastroenterology Physician in Sherwood, AR
• Providers in Sherwood, AR by specialty
• Pediatric Gastroenterology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.