NPIMap

Individual provider Active NPI

John Kierstead

  • Emergency Medicine Physician
  • Little Rock, AR
National Provider Identifier
1972035558
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
E-13079 Issued in AR
Practice address
2 Saint Vincent Cir
Little Rock, AR 72205-5423
Phone
(501) 552-4715
NPI assigned
Apr 1, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X E-13079 AR Primary

Addresses

Primary practice location

2 Saint Vincent Cir
Little Rock, AR 72205-5423

Mailing address

2 Saint Vincent Cir
Little Rock, AR 72205-5423

Other practice location 1

4301 W Markham St
Little Rock, AR 72205-7101
Phone (501) 686-8166

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20210722003088 CO Practitioner - Emergency Medicine 4082984919 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Arizona College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1024 S Lemay Ave
Poudre Valley Hospital
Fort Collins, CO 80524-3929
Phone (970) 495-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-13079ARMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of the Rockies, PC Emergency Medicine CurrentSince Aug 1, 2021 Accepting new patients
Emergency Physicians of the Rockies, PC Emergency Medicine CurrentSince Aug 1, 2021 Accepting new patients

Locations

1024 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 495-7000

2500 Rocky Mountain Ave
Loveland, CO 80538
Phone (970) 297-6425

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 and National Provider Directory roles.

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1972035558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 SAINT VINCENT CIR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SAINT VINCENT CIR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055423",
            "telephone_number": "501-552-4715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 W Markham St",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722057101",
            "country_code": "US",
            "telephone_number": "501-686-8166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIERSTEAD",
        "first_name": "JOHN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-01",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E-13079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.