Jimmerson Family Health Care P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E-1845 Issued in AR

Legal business name

JIMMERSON FAMILY HEALTH CARE P.A.

Practice address

6917 Geyer Springs Rd
Suite 4S
Little Rock, AR 72209-2727

Phone

(501) 569-9961

Fax

(501) 569-9903

NPI assigned

Apr 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Robert Tyray Jimmerson II, M.D.NPI 1619046679

Title

Physician

Phone

(501) 569-9961

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21757/brand/1/csg/1/fhir/r4

Practitioners 4

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

• Robert Tyray Jimmerson II, M.D.

  • Family Medicine Physician
  • Little Rock, AR
  • NPI 1619046679
  Medicare reassignment NPD Authorized official
• Holli Nicole Banks-Giles, M.D.

  • Internal Medicine Physician
  • West Memphis, AR
  • NPI 1689644478
  NPD (past)
• Devin Nicole Daniel, APRN

  • Family Nurse Practitioner
  • Little Rock, AR
  • NPI 1154638179

  Single Specialty

  NPD (past)
• Chrystal Dian Johnson, M.D.

  • Family Medicine Physician
  • Hensley, AR
  • NPI 1497836563
  NPD (past)

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1649496357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6917 GEYER SPRINGS RD",
            "address_2": "SUITE 4S",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722092727",
            "telephone_number": "501-569-9961",
            "fax_number": "501-569-9903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6917 GEYER SPRINGS RD",
            "address_2": "SUITE 4S",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722092727",
            "telephone_number": "501-569-9961",
            "fax_number": "501-569-9903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIMMERSON FAMILY HEALTH CARE P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "JIMMERSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "TYRAY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "501-569-9961",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-1845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUAL CHOICE",
            "identifier": "18321000000",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135241001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2451550",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2717169",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5K890",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTOGBA",
            "identifier": "080158974",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jill Gorman LPC LLC
• Jillian Carlan Counseling PLLC
• Jim Cornwell O.D.
• Jim J Moore MD, PA
• Casandra Jimerson
• Kayla Jimmerson
• Robert Tyray Jimmerson II, M.D.
• Aparna Jindal, MD
• Ravi Jindal, MBBS DNB
• Walter Gene Jines, DDS

• 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 May 6, 2008; 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.