NPIMap

Individual provider Active NPI

Tabasum Imran, MD

  • Family Medicine Physician
  • Fort Smith, AR
National Provider Identifier
1801057583
Registry record updated Apr 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E6776 Issued in AR
Practice address
1301 S E St
Fort Smith, AR 72901-4716
Phone
(479) 785-2431
Fax
(479) 494-7787
NPI assigned
Jun 24, 2008
Last updated
Apr 14, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E6776 AR Primary

Addresses

Primary practice location

1301 S E St
Fort Smith, AR 72901-4716

Mailing address

612 S 12TH St
Fort Smith, AR 72901-4702
Phone (479) 785-2431

Other identifiers 2

IdentifierTypeStateIssuer
187256001MedicaidAR
200232010AMedicaidOK

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
I20110620000399 AR Practitioner - Family Practice 1759569858 Reassigns benefits to 10 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital BoonevilleGroup PAC ID 1951530385, shared by 5 NPIs, 13 clinicians

Practice addresses (Care Compare)

128 Daniel Dr
Booneville, AR 72927-4055
Phone (479) 675-2455

1301 S E St
Fort Smith, AR 72901-3892
Phone (479) 785-2431

500 E Academy
Paris, AR 72855-4040
Phone (479) 963-6101

7001 Rogers Ave
Suite 200
Fort Smith, AR 72903-4022
Phone (479) 314-4620

880 W Main
Booneville, AR 72927-3443
Phone (479) 675-2800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E6776ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Waldron CurrentSince Mar 1, 2023 Accepting new patients
Mercy Hospital Booneville CurrentSince Mar 27, 2016 Accepting new patients
Mercy Hospital Ozark CurrentSince Sep 30, 2022 Accepting new patients
Mercy Hospital Paris CurrentSince Sep 30, 2022 Accepting new patients
Mercy Hospital Waldron Current Accepting new patients
Mercy Hospital Paris CurrentSince Sep 30, 2022 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Jan 1, 2014 Accepting new patients
Mercy Hospital Ozark CurrentSince Sep 30, 2022 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Jan 1, 2014 Accepting new patients
Mercy Hospital Waldron Current Accepting new patients
Mercy Hospital Booneville CurrentSince Mar 27, 2016 Accepting new patients
University of Arkansas for Medical Sciences Family Medicine Past Accepting new patients
Baptist Health Regional Hospitals Past Accepting new patients

Locations

128 Daniel Dr
Booneville, AR 72927
Phone (479) 675-2455

880 W Main St
Booneville, AR 72927
Phone (479) 675-2800

7001 Rogers Ave
Ste 200
Fort Smith, AR 72903
Phone (479) 314-4620

801 W River St
Ozark, AR 72949
Phone (479) 667-4138

500 E Academy St
Paris, AR 72855
Phone (479) 963-6101

1341 W 6th St
Waldron, AR 72958
Phone (479) 637-2136

Interoperability endpoints

  • Direct secure messaging: timran486990@directb.mercy.net

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 4

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": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492128000000",
    "number": "1801057583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 S 12TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729014702",
            "telephone_number": "479-785-2431",
            "fax_number": "479-494-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 S E ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729014716",
            "telephone_number": "479-785-2431",
            "fax_number": "479-494-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMRAN",
        "first_name": "TABASUM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-24",
        "last_updated": "2017-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E6776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187256001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200232010A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.