NPIMap

Individual provider Active NPI

Shelly C Bray, M.D.

  • Family Medicine Physician
  • Arkadelphia, AR
National Provider Identifier
1902824162
Registry record updated Jan 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-4195 Issued in AR
Practice address
303 Professional Park Dr
Arkadelphia, AR 71923-5317
Phone
(870) 464-1515
Fax
(870) 464-1514
NPI assigned
Jul 17, 2006
Last updated
Jan 24, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2020

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 E-4195 AR Primary

Addresses

Primary practice location

303 Professional Park Dr
Arkadelphia, AR 71923-5317

Mailing address

303 Professional Park Dr
Arkadelphia, AR 71923-5317
Phone (870) 464-1515

Other identifiers 4

IdentifierTypeStateIssuer
762691OtherARHEALTHLINK
7373851OtherARAETNA
06080018100OtherARQUALCHOICE
155215001MedicaidAR

Other names 1

  • Shelly Conly Perrin Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address shelly.bray.1@10828.direct.athenahealth.com Direct

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
I20041130000264 AR Practitioner - Family Practice 6507821774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

303 Professional Park Dr
Arkadelphia, AR 71923-5317
Phone (870) 464-1515

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-4195ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bray Family Medicine, PLLC CurrentSince Feb 6, 2015 Accepting new patients
West Leslie ER Physicians LLC Emergency Medicine Past Accepting new patients

Locations

303 Professional Park Dr
Arkadelphia, AR 71923
Phone (870) 403-1225

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10828/brand/1/csg/1/fhir/r4
  • Direct secure messaging: shelly.bray.1@10828.direct.athenahealth.com
  • Direct secure messaging: shellybray@direct.meditouchehr.com

Organizations & group practices 2

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1902824162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 PROFESSIONAL PARK DR",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719235317",
            "telephone_number": "870-464-1515",
            "fax_number": "870-464-1514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 PROFESSIONAL PARK DR",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719235317",
            "telephone_number": "870-464-1515",
            "fax_number": "870-464-1514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAY",
        "first_name": "SHELLY",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-4195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "762691",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7373851",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "06080018100",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155215001",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shelly.bray.1@10828.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "303 Professional Park Dr",
            "city": "Arkadelphia",
            "state": "AR",
            "country_code": "US",
            "postal_code": "719235317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "PERRIN",
            "middle_name": "CONLY",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Arkadelphia, AR

Sources for this page

Verify at the official NPI Registry.