NPIMap

Individual provider Active NPI

Ricky Dean Tate, MD

  • Internal Medicine Physician
  • Jonesboro, AR
National Provider Identifier
1861488017
Registry record updated Apr 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E2224 Issued in AR
Practice address
300 Carson St
Jonesboro, AR 72401-3104
Phone
(870) 932-1198
Fax
(870) 910-7700
NPI assigned
Sep 23, 2005
Last updated
Apr 28, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

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 E2224 AR Primary

Addresses

Primary practice location

300 Carson St
Jonesboro, AR 72401-3104

Mailing address

300 Carson St
Jonesboro, AR 72401-3104
Phone (870) 932-1198

Other identifiers 1

IdentifierTypeStateIssuer
137536001MedicaidAR

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
I20100802000524 AR Practitioner - Internal Medicine 0547393233 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Bernards Hospital Inc.Group PAC ID 0941105480, shared by 10 NPIs, 187 clinicians
St Bernards Physician Clinics IncGroup PAC ID 7012311269, 211 clinicians

Practice addresses (Care Compare)

225 E Washington Ave
Jonesboro, AR 72401-3111
Phone (870) 972-4100

225 E Washington Ave
St Bernards Medical Center
Jonesboro, AR 72401-3119
Phone (870) 972-4100

300 Carson St
Jonesboro, AR 72401-3104
Phone (870) 932-1198

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E2224ARMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Bernards Hospital Inc CurrentSince Jul 15, 1999 Accepting new patients
St Bernards Hospital Inc. CurrentSince Jul 15, 1999 Accepting new patients
St Bernards Physician Clinics Inc CurrentSince Jan 1, 2023 Accepting new patients
St Bernards Physician Clinics Inc CurrentSince Jan 1, 2023 Accepting new patients

Locations

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

1007 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 336-0472

1201 Fleming Ave
Jonesboro, AR 72401
Phone (870) 932-0440

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

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

Interoperability endpoints

  • Direct secure messaging: rtate@sbpc.medalliesdirect.net

Organizations & group practices 4

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 8

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1861488017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104",
            "telephone_number": "870-932-1198",
            "fax_number": "870-910-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CARSON ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013104",
            "telephone_number": "870-932-1198",
            "fax_number": "870-910-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "RICKY",
        "middle_name": "DEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E2224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137536001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.