NPIMap

Organization Active NPI

Northeast Arkansas Community Mental Health Center Inc

Doing business as Mid-South Health Systems Inc

  • Family Medicine Physician
  • Blytheville, AR
National Provider Identifier
1043885759
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Doing business as
Mid-South Health Systems Inc
Practice address
209 S Lockard St
Blytheville, AR 72315-2541
Phone
(870) 763-2139
NPI assigned
May 25, 2021
Last updated
Apr 22, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

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

Authorized official

Name
Carla Pratt
Title
Business Manager
Phone
(870) 972-4016

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

209 S Lockard St
Blytheville, AR 72315-2541

Mailing address

2707 Browns LN
Jonesboro, AR 72401-7213

Other names 1

  • Mid-South Health Systems Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040110000206 AR Part B Supplier - Clinic/Group Practice 0244130839 Receives reassigned benefits from 43 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marianna, AR; Pocahontas, AR; Melbourne, AR; Newport, AR; Paragould, AR; Salem, AR; Searcy, AR; Truman, AR…

Other NPIs on the same Medicare enrollment 28

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

View all 28

National Provider Directory

National Provider Directory
Tax ID family
Northeast Arkansas Community Mental Health Center Inc43 organizations share this tax ID, including this one
Part of
Northeast Arkansas Community Mental Health Center Inc

Other organizations with this tax ID 42

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

View all 42

Locations

602 David St
Corning, AR 72422
Phone (870) 857-3655

507 Missouri
Helena, AR 72342
Phone (870) 338-3434

3700 Access Rd
Jonesboro, AR 72401
Phone (870) 972-4000

444 Atkins Blvd
Marianna, AR 72360
Phone (870) 270-7698

111 W Booth Rd
Searcy, AR 72143
Phone (870) 919-6320

1201 Falls Blvd S
Wynne, AR 72396
Phone (870) 238-1135

Practitioners & affiliated clinicians

Practitioners 57

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 57

NPI Registry JSON

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1043885759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 BROWNS LN",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 S LOCKARD ST",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723152541",
            "telephone_number": "870-763-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC",
        "enumeration_date": "2021-05-25",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "PRATT",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "870-972-4016"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid-South Health Systems Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mid-South Health Systems Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blytheville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; 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.