NPIMap

Individual provider Active NPI

Christian Dupre Simmons, M.D./PH.D.

  • Vascular Surgery Physician
  • Little Rock, AR
National Provider Identifier
1619234366
Registry record updated Jul 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
E10786 Issued in AR
Practice address
4301 W Markham St # 520
Little Rock, AR 72205
Phone
(501) 686-8000
NPI assigned
Apr 19, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X E10786 AR Primary

Addresses

Primary practice location

4301 W Markham St # 520
Little Rock, AR 72205

Mailing address

PO Box 251420
Little Rock, AR 72225-1420
Phone (501) 686-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170815002255 AR Practitioner - Vascular Surgery 5597082834 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Arkansas College of Medicine, 2012
Medicare assignment
May accept Medicare assignment
Group practices
Arkansas Vascular and Vein Specialists, PLLCGroup PAC ID 5890167423, 4 clinicians

Practice addresses (Care Compare)

10310 W Markham St
Suite 100
Little Rock, AR 72205-1581
Phone (501) 712-2571

525 Western Ave
Suite 203
Conway, AR 72034-4980
Phone (501) 327-4828

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal14
Leg revascularization (restoring blood flow)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E10786ARMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Treatment Centers of America, PLLC CurrentSince Jan 13, 2023 Accepting new patients
Conway Regional Medical Center Inc CurrentSince Mar 1, 2024 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Jul 1, 2020 Accepting new patients
Arkansas Vascular and Vein Specialists, PLLC Vascular Surgery CurrentSince Jan 1, 2023 Accepting new patients
Pain Treatment Centers of America PLLC CurrentSince Jan 13, 2023 Accepting new patients
Conway Regional Medical Center Inc CurrentSince Mar 1, 2024 Accepting new patients
Conway Regional Medical Center Inc Past Accepting new patients

Locations

1215 Sidney St
Batesville, AR 72501
Phone (870) 262-1541

525 Western Ave
Ste 203
Conway, AR 72034
Phone (501) 327-4828

10310 W Markham St
Ste 100
Little Rock, AR 72205
Phone (501) 424-4738

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

Interoperability endpoints

  • Direct secure messaging: christian.simmons@4089.securemail.prognocis.com

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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": "1334793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1619234366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251420",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722251420",
            "telephone_number": "501-686-8000",
            "fax_number": "501-526-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 520",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72205",
            "telephone_number": "501-686-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "CHRISTIAN",
        "middle_name": "DUPRE",
        "name_prefix": "Dr.",
        "credential": "M.D./PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-19",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AR",
            "license": "E10786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.