Robert Tyray Jimmerson II, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E-1845 Issued in AR

Practice address

500 S University Ave
Suite 515
Little Rock, AR 72205-5306

Phone

(501) 569-9961

Fax

(501) 400-8649

NPI assigned

Nov 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

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

Specialty

Family Practice

Education

Meharry Medical College School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21757/brand/1/csg/1/fhir/r4
• Direct secure messaging: robert.jimmerson.1@21757.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.

• Jimmerson Family Health Care P.a.

  • Family Medicine Physician
  • Little Rock, AR
  • NPI 1649496357
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403827200000",
    "number": "1619046679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE",
            "address_2": "SUITE 515",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055306",
            "telephone_number": "501-569-9961",
            "fax_number": "501-400-8649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE",
            "address_2": "SUITE 515",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055306",
            "telephone_number": "501-569-9961",
            "fax_number": "501-400-8649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMMERSON",
        "first_name": "ROBERT",
        "middle_name": "TYRAY",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2014-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-1845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5K890",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUAL CHOICE",
            "identifier": "18321000000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTOGBA",
            "identifier": "080158974",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2451550",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135241001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2717169",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jim Cornwell O.D.
• Jim J Moore MD, PA
• Casandra Jimerson
• Jimmerson Family Health Care P.a.
• Kayla Jimmerson
• Aparna Jindal, MD
• Ravi Jindal, MBBS DNB
• Walter Gene Jines, DDS
• JK Williamson Consulting
• JLM Ventures, Inc. (Grow Learning Centre)

• Family Medicine Physician in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.