NPIMap

Organization Active NPI

Baxter County Regional Hospital Inc.

Doing business as Baxter Regional Urology Clinic

  • Urology Physician
  • Mountain Home, AR
National Provider Identifier
1003086646
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
E4783 Issued in AR
Legal business name
BAXTER COUNTY REGIONAL HOSPITAL INC.
Doing business as
Baxter Regional Urology Clinic
Practice address
628 Hospital Dr
Suite 3a
Mountain Home, AR 72653-2953
Phone
(870) 508-6020
Fax
(870) 508-6025
NPI assigned
Mar 11, 2008
Last updated
Oct 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Authorized official

Name
Debra Henry
Title
Cfo
Phone
(870) 508-1033

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X E4783 AR Primary

Addresses

Primary practice location

628 Hospital Dr
Suite 3a
Mountain Home, AR 72653-2953

Mailing address

628 Hospital Dr
Suite 3a
Mountain Home, AR 72653-2953
Phone (870) 508-6020

Other names 1

  • Baxter Regional Urology Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080515000349 AR Part B Supplier - Clinic/Group Practice 0042389264 Receives reassigned benefits from 7 practitioners
Practice locations: Ash Flat, AR; Harrison, AR; Melbourne, AR; Mountain Home, AR; Mountain View, AR
O20220203001897 MO Part B Supplier - Clinic/Group Practice 0042389264 Receives reassigned benefits from 1 practitioner
Practice locations: West Plains, MO

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Baxter Co Reg Hospital Inc16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

49 Highway 62 412
#B
Ash Flat, AR 72513
Phone (870) 508-6020

628 Hospital Dr
Mountain Home, AR 72653
Phone (870) 508-3250

103 Mountain Place Dr
Ste E
Mountain View, AR 72560
Phone (870) 425-8288

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1003086646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 HOSPITAL DR",
            "address_2": "SUITE 3A",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532953",
            "telephone_number": "870-508-6020",
            "fax_number": "870-508-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 HOSPITAL DR",
            "address_2": "SUITE 3A",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532953",
            "telephone_number": "870-508-6020",
            "fax_number": "870-508-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAXTER COUNTY REGIONAL HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-508-1033"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "AR",
            "license": "E4783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baxter Regional Urology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.