Shamsul Alam MD PA

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

E4954 Issued in AR

Legal business name

SHAMSUL ALAM MD PA

Doing business as

The Kidney Clinic

Practice address

2618 SE J St
Suite#4
Bentonville, AR 72712-3767

Phone

(479) 271-9393

Fax

(479) 271-9393

NPI assigned

Sep 14, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Shamsul Alam, M.D.NPI 1912953373

Title

President

Phone

(479) 271-9393

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Kidney Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shamsul Alam, M.D.

  • Nephrology Physician
  • Bentonville, AR
  • NPI 1912953373
  Medicare reassignment Care Compare group Authorized official
• Valerie Bedwell

  • Family Nurse Practitioner
  • Bentonville, AR
  • NPI 1013394287
  Medicare reassignment Care Compare group NPD
• Kristine Kwon Rowland, APRN

  • Acute Care Nurse Practitioner
  • Bentonville, AR
  • NPI 1326574625
  Medicare reassignment NPD
• Leann W Metheny, DNP, FNP-BC, NP-C

  • Nurse Practitioner
  • Springdale, AR
  • NPI 1598052250
  NPD (past)
• Bryan M Sheehan, DPM

  • Podiatrist
  • Grove, OK
  • NPI 1427031863
  NPD (past)

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456876800000",
    "number": "1639487564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1037",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727121037",
            "telephone_number": "479-271-9393",
            "fax_number": "479-271-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2618 SE J ST",
            "address_2": "SUITE#4",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123767",
            "telephone_number": "479-271-9393",
            "fax_number": "479-271-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAMSUL ALAM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-14",
        "last_updated": "2016-03-02",
        "status": "A",
        "authorized_official_last_name": "ALAM",
        "authorized_official_first_name": "SHAMSUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-271-9393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "AR",
            "license": "E4954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "5G686",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Kidney Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Settler, RD, LD
• John Sevier, LPC
• Jeanie Ray Shade, LCSW
• Karl David Shade
• Kathryn M Shaffer, LPC
• Tiffany Lynn Shanahan, NP-C
• Shanna M. Molina MD PLLC
• Shannon Candid Arkansas, P.a.
• John Lark Shasteen, LCSW
• Ayesha Shaukat, RPH

• Nephrology Physician in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Nephrology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.