NPIMap

Organization Active NPI

Hope Medical Clinic Inc

  • Rural Health Clinic/Center
  • Clinton, AR
National Provider Identifier
1013245471
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HOPE MEDICAL CLINIC INC
Practice address
145 Shake Rag Rd
Clinton, AR 72031-6682
Phone
(501) 745-7161
Fax
(501) 745-8714
NPI assigned
Nov 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

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

Authorized official

Name
Mrs. Stefanie Shaver
Title
Office Manager
Phone
(501) 745-7161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

145 Shake Rag Rd
Clinton, AR 72031-6682

Mailing address

145 Shake Rag Rd
Clinton, AR 72031-6682
Phone (501) 745-7161

Other identifiers 1

IdentifierTypeStateIssuer
185295729MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100219000056 AR Part B Supplier - Clinic/Group Practice 9739223462 Receives reassigned benefits from 4 practitioners
Practice locations: Clinton, AR
O20100716000453 AR Part A Provider - Rural Health Clinic 9739223462 Practice locations: Clinton, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013245471. Details of each certification follow.

Rural health clinic certification: CCN 043832

Legal name
HOPE MEDICAL CLINIC INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 16, 1994
Last certification
May 6, 2025
Ownership / control type
1B
Most recent change of ownership
Jun 1, 2005 (1 total)
Organization structure
OtherProprietary
Incorporated
Nov 13, 2009 in AR
Enrollment address
145 Shake Rag Rd
Clinton, AR 72031-6682

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Nichole D Clark Individual 5% Or Greater Direct Ownership InterestAprn / Owner Nov 13, 2009 100%
Corporate Director Jul 1, 2010
W-2 Managing Employee Jul 1, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

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": "1259020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411344000000",
    "number": "1013245471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 SHAKE RAG RD",
            "city": "CLINTON",
            "state": "AR",
            "postal_code": "720316682",
            "telephone_number": "501-745-7161",
            "fax_number": "501-745-8714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 SHAKE RAG RD",
            "city": "CLINTON",
            "state": "AR",
            "postal_code": "720316682",
            "telephone_number": "501-745-7161",
            "fax_number": "501-745-8714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOPE MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-24",
        "last_updated": "2014-09-22",
        "status": "A",
        "authorized_official_last_name": "SHAVER",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "501-745-7161",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185295729",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, AR

Sources for this page

Verify at the official NPI Registry.