Active NPI
Shamsul Alam, M.D.
- Nephrology Physician
- Bentonville, AR
National Provider Identifier
1912953373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- E4954
- Practice address
- 2618 SE J St
Suite # 2 & 4
Bentonville, AR 72712-3767 - Phone
- (479) 271-9393
- Fax
- (479) 271-0141
- NPI assigned
- May 26, 2006
- Last updated
- Sep 28, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | E4954 | AR | Primary |
Addresses
Primary practice location
2618 SE J St
Suite # 2 & 4
Bentonville, AR 72712-3767
Mailing address
11149 Cobblestone
Bentonville, AR 72712-7379
Phone (479) 271-9393
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200277530A | Medicaid | OK | |
| A68252001 | Medicaid | AR | |
| 27959 | Other | OK | OKLAHOMA STATE MEDICAL LICENSE |
| 168252001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nephrology
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2618 SE J St
Bentonville, AR 72712-3857
Phone (479) 271-9393
2618 SE J Street
Suite 4
Bentonville, AR 72712-3857
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Benton County Physician Services LLC | Current | Accepting new patients | |
| Ankle & Foot Centers of Mid-America | Past | Accepting new patients | |
| Medcentral Professional Foundation, LLC | Past | Accepting new patients |
Locations
811 SE 28th St
Ste 7
Bentonville, AR 72712
Phone (479) 271-2350
101 Sun Meadow Dr
Centerton, AR 72719
Phone (479) 273-1426
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.
-
- Family Medicine Physician
- Bentonville, AR
- NPI 1871553073
-
- Foot & Ankle Surgery Podiatrist
- Grove, OK
- NPI 1669694170
-
- Facial Plastic Surgery Physician
- Mansfield, OH
- NPI 1841476942
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Springdale Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Springdale, AR
- NPI 1740468644
Dialysis facility
-
dba Mercy Hospital Northwest Arkansas
- General Acute Care Hospital
- Rogers, AR
- NPI 1316902414
-
dba Northwest Medical Center
- General Acute Care Hospital
- Springdale, AR
- NPI 1699726695
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443398400000",
"number": "1912953373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11149 COBBLESTONE",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727127379",
"telephone_number": "479-271-9393",
"fax_number": "479-271-0141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2618 SE J ST",
"address_2": "SUITE # 2 & 4",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727123767",
"telephone_number": "479-271-9393",
"fax_number": "479-271-0141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALAM",
"first_name": "SHAMSUL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2015-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "AR",
"license": "E4954",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200277530A",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "A68252001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OKLAHOMA STATE MEDICAL LICENSE",
"identifier": "27959",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "168252001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bentonville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.