NPIMap

Individual provider Active NPI

Marvin Bruce Sanderson, M.D.

  • Internal Medicine Physician
  • Little Rock, AR
National Provider Identifier
1700846870
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C4641 Issued in AR
Practice address
500 S University Ave Ste 701
Little Rock, AR 72205-5309
Phone
(501) 664-5119
Fax
(501) 664-4209
NPI assigned
Mar 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X C4641 AR Primary

Addresses

Primary practice location

500 S University Ave Ste 701
Little Rock, AR 72205-5309

Mailing address

500 S University Ave Ste 701
Little Rock, AR 72205-5309
Phone (501) 664-5119

Other identifiers 1

IdentifierTypeStateIssuer
104566001MedicaidAR

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
I20100104000022 AR Practitioner - Internal Medicine 2365583069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Arkansas College of Medicine, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

500 S University Ave
Suite 701
Little Rock, AR 72205-5309
Phone (501) 664-5119

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
60.27 of 100Reported as individual
Quality
83.33
Improvement activities
0
Cost
76.35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C4641ARMDInternal Medicine Physician

Organizations & group practices 1

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 7

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": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1700846870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE STE 701",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055309",
            "telephone_number": "501-664-5119",
            "fax_number": "501-664-4209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE STE 701",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055309",
            "telephone_number": "501-664-5119",
            "fax_number": "501-664-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "MARVIN",
        "middle_name": "BRUCE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "C4641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104566001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.