NPIMap

Organization Active NPI

John Ed Chambers Memorial Hospital, Inc.

Doing business as Chambers Memorial Clinic

  • Primary Care Clinic/Center
  • Danville, AR
National Provider Identifier
1073748406
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.
Doing business as
Chambers Memorial Clinic
Practice address
719 Detroit Ave
Danville, AR 72833-9607
Phone
(479) 495-2241
Fax
(479) 495-6223
NPI assigned
May 29, 2009
Last updated
Jan 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Authorized official

Name
Paula Michaelle Cornwell
Title
Cfo
Phone
(479) 495-2241

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

719 Detroit Ave
Danville, AR 72833-9607

Mailing address

PO Box 639
Danville, AR 72833-0639
Phone (479) 495-2241

Other identifiers 2

IdentifierTypeStateIssuer
113073002MedicaidAR
195803002MedicaidAR

Other names 1

  • Chambers Memorial Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050308000661 AR Part B Supplier - Clinic/Group Practice 4688628167 Receives reassigned benefits from 17 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Danville, AR; Plainview, AR; Havana, AR; Ola, AR
O20070313000287 AR Part A Provider - Hospital 4688628167 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Danville, AR; Plainview, AR; Havana, AR; Ola, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073748406. Details of each certification follow.

Hospital certification: CCN 040011

Legal name
JOHN ED CHAMBERS MEMORIAL HOSPITAL INC
Doing business as
CHAMBERS MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 30, 2021
Beds
42
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 29, 1997 in AR
Enrollment address
719 Detroit Avenue
Danville, AR 72833-0639
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Chambers Memorial HospitalCCN 040011 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

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
John Chambers Individual Corporate Director Mar 12, 1984
Michael Peek Individual Corporate OfficerCeo Jun 1, 2021 100%
W-2 Managing EmployeeCeo Jun 1, 2021 100%
Operational/Managerial ControlCeo Jun 1, 2021 100%
Tommy D Papasan Individual Corporate DirectorBoard of Directors Jul 16, 2014
John Ed Chambers Memorial Hospital Inc Organization, Danville, AR Corporation, Non-profit Operational/Managerial Control Jun 1, 2021 100%
Philip Alexander Individual Corporate Director Aug 18, 2004
Paul Sanders Individual Corporate Director Jul 1, 1995
Kayla Walker Individual W-2 Managing EmployeeBusiness Office Jun 1, 2021 1%
Operational/Managerial ControlBusiness Office Jun 1, 2021 1%
Paula M Cornwell Individual Corporate OfficerCfo Jan 1, 2021
W-2 Managing EmployeeCfo Jun 1, 2021 1%
Operational/Managerial ControlCfo Jun 1, 2021 1%
David Fisher Individual Corporate Director Jul 9, 1984
Ritchie Tippin Individual Corporate Director Jul 14, 1986

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 42

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1243555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1073748406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "DANVILLE",
            "state": "AR",
            "postal_code": "728330639",
            "telephone_number": "479-495-2241",
            "fax_number": "479-495-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 DETROIT AVE",
            "city": "DANVILLE",
            "state": "AR",
            "postal_code": "728339607",
            "telephone_number": "479-495-2241",
            "fax_number": "479-495-6223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-29",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-10",
        "status": "A",
        "authorized_official_last_name": "CORNWELL",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "MICHAELLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "479-495-2241"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113073002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195803002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chambers Memorial Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chambers Memorial Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Danville, AR

Sources for this page

Verify at the official NPI Registry.