Rose Marie Shaw-Bullock, M.D.
Individual provider Active NPI Family Medicine Physician · N Little Rock, AR
NPI 1790749943 · NPPES record last updated Aug 2, 2010
Key facts
- NPI
- 1790749943
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E0873 (AR)
- Practice address
- 400 W Pershing Blvd
N Little Rock, AR 72114-2146 - Phone
- (501) 771-7717
- Fax
- (501) 771-0550
- NPI assigned
- Apr 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Arkansas College of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- North Little Rock Primary Care and Diagnostic Clinic PLLC
Arkansas Primary Care Clinics PA
Practice addresses (Care Compare)
400 W Pershing Blvd
North Little Rock, AR 72114-2146
Phone (501) 771-7717
6209 W 12TH St
Little Rock, AR 72204-1505
Phone (501) 663-5221
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110720000246 | AR | Practitioner - Family Practice | 5597933473 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E0873 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arkansas Primary Care Clinics PA | Family Medicine | Current |
Accepting new patients |
| North Little Rock Primary Care and Diagnostic Clinic PLLC | Family Medicine | Current |
Accepting new patients |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Locations
6209 W 12th St
Little Rock, AR 72204
Phone (501) 663-5221
400 W Pershing Blvd
North Little Rock, AR 72114
Phone (501) 771-7717
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | E0873 | AR | Yes |
Addresses
Primary practice location
400 W Pershing Blvd
N Little Rock, AR 72114-2146
Mailing address
400 W Pershing Blvd
N Little Rock, AR 72114-2146
Phone (501) 771-7717
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 132896001 | Medicaid | AR |
Other providers in N Little Rock, AR
- Robin Reynolds
- Ritchie and Flaherty Dental PLLC
- Wade William Robertson
- Chasity Elizabeth Rogers
- Chelsea Seelinger
- Andrea J. Sieczkowski
- Peter Singer
- Brad Smith
- James Kirby Smith
- Stonebriar Imaging of North Little Rock LLC
All providers in N Little Rock, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.