NPIMap

Individual provider Active NPI

Ezekiel Elliott Shotts, M.D.

  • Diagnostic Radiology Physician
  • Jonesboro, AR
National Provider Identifier
1679715130
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
E-7845 Issued in AR
Practice address
225 E Washington Ave
Jonesboro, AR 72401-3111
Phone
(870) 910-6654
Fax
(870) 932-0526
NPI assigned
Mar 30, 2009
Last updated
Nov 17, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X E-7845 AR Primary

Addresses

Primary practice location

225 E Washington Ave
Jonesboro, AR 72401-3111

Mailing address

800 S Church St
Ste 101
Jonesboro, AR 72401-4154
Phone (870) 932-0639

Other identifiers 1

IdentifierTypeStateIssuer
ENROLLEDMedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140805001585 AR Practitioner - Diagnostic Radiology 3577757756 Reassigns benefits to 2 organizations
I20180816001808 MO Practitioner - Diagnostic Radiology 3577757756 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Bernards Physician Clinics IncGroup PAC ID 7012311269, 211 clinicians
Associated Radiologists LTDGroup PAC ID 8123009941, 38 clinicians

Practice addresses (Care Compare)

1312 1St St
Kennett, MO 63857-2526
Phone (573) 559-2780

225 E Jackson Ave
Jonesboro, AR 72401-3119
Phone (870) 972-4555

225 E Washington Ave
Jonesboro, AR 72401-3111
Phone (970) 207-4100

800 S Church St
Suite 101
Jonesboro, AR 72401-4154
Phone (870) 932-0639

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-7845ARMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Radiologists, LTD. Diagnostic Radiology CurrentSince Jan 3, 2017 Accepting new patients
St Bernards Physician Clinics Inc CurrentSince May 1, 2023 Accepting new patients
Arcare Current Accepting new patients
Arcare CurrentSince Oct 10, 2024 Accepting new patients
St Bernards Physician Clinics, Inc. Current Accepting new patients
St.Bernards Pet Center LLC Diagnostic Radiology CurrentSince Oct 1, 2016 Accepting new patients
St Bernards Physician Clinics Inc Diagnostic Radiology CurrentSince May 1, 2023 Accepting new patients
Arcare CurrentSince Oct 10, 2024 Accepting new patients

Locations

623 N 9th St
#40
Augusta, AR 72006

1005 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 935-1242

225 E Washington Ave
Jonesboro, AR 72401
Phone (870) 207-1630

800 S Church St
Ste 101
Jonesboro, AR 72401

1312 1st St
Kennett, MO 63857
Phone (573) 559-2780

1312 1st St
Ste B
Kennett, MO 63857
Phone (573) 559-2780

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1238371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1679715130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S CHURCH ST",
            "address_2": "STE 101",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014154",
            "telephone_number": "870-932-0639",
            "fax_number": "870-932-0526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E WASHINGTON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013111",
            "telephone_number": "870-910-6654",
            "fax_number": "870-932-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOTTS",
        "first_name": "EZEKIEL",
        "middle_name": "ELLIOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-30",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AR",
            "license": "E-7845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.