MGH SURGICALIST PLLC (NPI# 1063050573) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063050573 |
| Entity Type | Organization |
| Organization Name | MGH SURGICALIST PLLC |
| Practice Address |
5 Saint Vincent Cir Little Rock AR 72205-5412 |
| Mailing Address |
Po Box 21647 Tampa FL 33622-1647 |
| Practice Telephone | 8135305043 |
| Mailing Telephone | 8135305043 |
| Mailing Fax Number | 8135305043 |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2019-12-16 |
| Authorized Official Name | DR. MIT DESAI (CEO) |
| Authorized Official Telephone | 8135305043 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | THE SURGICALIST GROUP PLLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0127X |
Surgery Specialization: Trauma Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
5 SAINT VINCENT CIR |
| City | LITTLE ROCK |
| State | AR |
| Zip Code | 72205-5412 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871585752 | Larry L Nguyen | Orthopaedic Surgery | 5 Saint Vincent Cir, Suite 100, Little Rock, AR 72205-5412 | 2005-08-17 |
| 1376903823 | Shannon Diane Hoey | Nurse Practitioner | 5 Saint Vincent Cir, Suite 501, Little Rock, AR 72205-5412 | 2016-02-26 |
| 1467832170 | Keith Sholes | Pharmacist | 5 Saint Vincent Cir, Little Rock, AR 72205-5412 | 2015-06-08 |
| 1407249311 | Tiffanie Boyce | Physician Assistant | 5 Saint Vincent Cir, Ste 100, Little Rock, AR 72205-5415 | 2015-03-17 |
| 1629470521 | Little Rock Neurosurgery Clinic | Nurse Practitioner | 5 Saint Vincent Cir, Suite 502, Little Rock, AR 72205-5412 | 2014-09-23 |
| 1932448792 | Arkansas Ophthalmology Associates, P.a. | Ophthalmology | 5 Saint Vincent Cir, Suite 200, Little Rock, AR 72205-5412 | 2013-02-13 |
| 1003170085 | Justin Scott Shipp | Specialist/Technologist | 5 Saint Vincent Cir, Little Rock, AR 72205-5412 | 2012-06-25 |
| 1003105289 | Jennifer Ann Minneman | Surgery | 5 Saint Vincent Cir, Little Rock, AR 72205-5412 | 2011-03-29 |
| 1346551314 | Thurston Matthew Bauer | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5 Saint Vincent Cir, Suite 501, Little Rock, AR 72205-5412 | 2010-06-24 |
| 1962642900 | Martin Bowen Hefley Knee & Sports Med. Ctr. | Physical Therapist | 5 Saint Vincent Cir, Suite 100, Little Rock, AR 72205-5412 | 2009-03-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932719465 | Darleisha Renee Stigall | Behavior Technician | 1210 Aldersdate Rd, Little Rock, AR 72205 | 2020-08-10 |
| 1316563638 | Unknown Amisha | Student in an Organized Health Care Education/Training Program | 4301 West Markham St, Slot #634, University of Arkansas, Little Rock, AR 72205 | 2020-06-23 |
| 1225667272 | Ann-marie Frances Hayre | Student in an Organized Health Care Education/Training Program | 4310 West Markham, Slot 589, Little Rock, AR 72205 | 2020-04-02 |
| 1952930075 | Alexandria Leigh Smith | Student in an Organized Health Care Education/Training Program | 4301 West Markham St, Slot 531, Little Rock, AR 72205 | 2020-04-02 |
| 1093353922 | Phil Fagala | Pharmacist | 614 North Beechwood, Little Rock, AR 72205 | 2019-12-10 |
| 1295391688 | Home To Community Living, Inc | Physical Therapist | 10201 W Markham Street Pulaski, Little Rock, AR 72205 | 2019-05-12 |
| 1669933693 | Sandy Louise Webb | Student in an Organized Health Care Education/Training Program | 4301 West Markham, Slot 530, Little Rock, AR 72205 | 2019-03-31 |
| 1457812828 | Vincent Battafarano | Student in an Organized Health Care Education/Training Program | 4301 West Markham, Slot 602, Little Rock, AR 72205 | 2019-03-28 |
| 1063978922 | Franks Pediatric Occupational Therapy LLC | Occupational Therapist | 5516 C St, Little Rock, AR 72205 | 2019-02-15 |
| 1497210199 | Integrative Counseling Center LLC | Counselor | 10515 W Markham St Ste D3, Little Rock, AR 72205 | 2019-02-06 |
| Find all providers in zip 72205 | ||||
| Taxonomy Code | 2086S0127X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Trauma Surgery |
| Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency. |
| Notes: Source: American Board of Surgery, 2007 [1/1/2008: definition added, source added] Additional Resources: http://www.absurgery.org/. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306136148 | Anna Privratsky | Surgery | 4301 W Markham St # 783, Little Rock, AR 72205-7101 | 2011-04-13 |
| 1588754154 | Ronald Robertson | Surgery | 4301 W Markham St # 783, Little Rock, AR 72205-7101 | 2006-10-13 |
| City | LITTLE ROCK |
| Zip Code | 72205 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.