NPIMap

Organization Active NPI

East Arkansas Family Health Center, Inc

Doing business as East Arkansas Family Health Center South

  • Federally Qualified Health Center (FQHC)
  • West Memphis, AR
National Provider Identifier
1033997275
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST ARKANSAS FAMILY HEALTH CENTER, INC
Doing business as
East Arkansas Family Health Center South
Practice address
301 W Polk Ave
West Memphis, AR 72301-4262
Phone
(870) 735-3842
NPI assigned
Sep 19, 2023
Last updated
Sep 19, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST ARKANSAS FAMILY HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Authorized official

Name
Susan W Ward-Jones, MD
Title
Ceo
Phone
(870) 733-6388

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

301 W Polk Ave
West Memphis, AR 72301-4262

Mailing address

900 N 7TH St
West Memphis, AR 72301-2001
Phone (870) 735-3842

Other names 1

  • East Arkansas Family Health Center South Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040719001289 AR Part B Supplier - Clinic/Group Practice 1052390390 Receives reassigned benefits from 29 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Helena, AR; West Memphis, AR
O20230927000049 AR Part A Provider - Federally Qualified Health Center (FQHC) 1052390390 Practice locations: West Memphis, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033997275. Details of each certification follow.

Federally qualified health center certification: CCN 041038

Legal name
EAST ARKANSAS FAMILY HEALTH CENTER, INC
Doing business as
EAST ARKANSAS FAMILY HEALTH CENTER SOUTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 25, 2023
Last certification
Sep 25, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1973 in AR
Enrollment address
301 W Polk Ave
West Memphis, AR 72301-4262

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2281782East Arkansas Family Health Center South301 W Polk, West Memphis, AR 72301Certificate of waiverMay 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Arkansas Family HL17 organizations share this tax ID, including this one
Part of
East Arkansas Family HL

Other organizations with this tax ID 16

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

View all 16

Locations

4102 Memorial Dr
Blytheville, AR 72315
Phone (870) 532-6001

801 Deadrick Rd
Forrest City, AR 72335
Phone (870) 633-2141

301 W Polk Ave
West Memphis, AR 72301
Phone (501) 735-0833

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Reena Holmes Individual Corporate OfficerCfo Jan 1, 2021
Susan Ward Jones Individual Corporate OfficerCeo Nov 1, 2006
W-2 Managing EmployeeCeo Nov 1, 2006
Larry Robinson Individual Corporate DirectorBoard Member Jun 18, 2014
Cynthia Conner Individual Corporate DirectorBoard Member Sep 9, 2016
Randall S Burcham Individual Corporate DirectorBoard Member May 26, 2015
Kyle Miller Individual Corporate DirectorBoard Member Sep 23, 2019
Sara Joplin Individual Corporate DirectorSecretary Aug 24, 2020
Dewayne Rose Individual Corporate DirectorBoard Member Feb 1, 2023
Sandra Teague Individual Corporate DirectorBoard Chair Jul 23, 2012
Tracy Evans Individual Corporate DirectorVice Chairman May 26, 2015

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Marion School District School Based Health CenterMarion, AR, CCN 041941 Federally qualified health center Operational/Managerial Control (100%) Aug 13, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1033997275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N 7TH ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723012001",
            "telephone_number": "870-735-3842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W POLK AVE",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723014262",
            "telephone_number": "870-735-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ARKANSAS FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST ARKANSAS FAMILY HEALTH CENTER INC",
        "enumeration_date": "2023-09-19",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-18",
        "status": "A",
        "authorized_official_last_name": "WARD-JONES",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-733-6388",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Arkansas Family Health Center South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Memphis, AR

Sources for this page

Verify at the official NPI Registry.