Individual provider Active NPI

Jimmy John Palakunnel, MD

  • Student in an Organized Health Care Education/Training Program
  • Little Rock, AR
National Provider Identifier
1992322358
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
4301 West Markham, Slot 556
Little Rock, AR 72205
Phone
(501) 603-1595
NPI assigned
Jul 1, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

4301 West Markham, Slot 556
Little Rock, AR 72205

Mailing address

2200 Riverfront Dr Apt 4307
Little Rock, AR 72202-2252
Phone (914) 758-3696

Other practice location 1

1 Children's Way
Slot 556
Little Rock, AR 72202
Phone (501) 686-6912

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200818003293 AR Order and Referring Only - Diagnostic RadiologyPractitioner - Diagnostic Radiology 0840616009

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1992322358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 RIVERFRONT DR APT 4307",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722022252",
            "telephone_number": "914-758-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 WEST MARKHAM, SLOT 556",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72205",
            "telephone_number": "501-603-1595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Children's Way",
            "address_2": "Slot 556",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "72202",
            "country_code": "US",
            "telephone_number": "501-686-6912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALAKUNNEL",
        "first_name": "JIMMY",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-01",
        "last_updated": "2024-04-30",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.