NPIMap

Organization Active NPI

Crossett Health Foundation

Doing business as Hamburg Health Clinic

  • Rural Health Clinic/Center
  • Hamburg, AR
National Provider Identifier
1093084808
Registry record updated Apr 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CROSSETT HEALTH FOUNDATION
Doing business as
Hamburg Health Clinic
Practice address
319 W Parker St
Hamburg, AR 71646-3121
Phone
(870) 853-8271
Fax
(870) 364-1245
NPI assigned
Dec 22, 2011
Last updated
Apr 9, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
CROSSETT HEALTH FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2013

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

Authorized official

Name
Mr. Phillip K Gilmore
Title
Ceo
Phone
(870) 364-1271

Specialties & licenses 1

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

Addresses

Primary practice location

319 W Parker St
Hamburg, AR 71646-3121

Mailing address

319 W Parker St
Hamburg, AR 71646-3121
Phone (870) 853-8271

Other identifiers 2

IdentifierTypeStateIssuer
163845729MedicaidAR
54255OtherARBLUE CROSS

Other names 1

  • Hamburg Health 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
O20120314000287 AR Part B Supplier - Clinic/Group Practice 9133030117 Receives reassigned benefits from 4 practitioners
Practice locations: Hamburg, AR
O20120711000370 AR Part A Provider - Rural Health Clinic 9133030117 Practice locations: Hamburg, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093084808. Details of each certification follow.

Rural health clinic certification: CCN 048501

Legal name
CROSSETT HEALTH FOUNDATION
Doing business as
HAMBURG HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2012
Last certification
Aug 11, 2023
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Oct 1, 1947 in AR
Enrollment address
319 W Parker St
Hamburg, AR 71646-3121
Related CCNs
041323

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

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Ashley Memorial Hospita9 organizations share this tax ID, including this one
Part of
Ashley Memorial Hospita

Other organizations with this tax ID 8

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

351 W Parker St
Hamburg, AR 71646
Phone (870) 853-8271

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GICHCD

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Phillip Gilmore Individual Corporate OfficerCeo Jul 1, 2004 100%
Corporate DirectorCeo Jul 1, 2004 100%
W-2 Managing Employee Jan 1, 2012
Operational/Managerial Control Jul 1, 2004 100%
Pam Stell Individual Corporate Director Jan 1, 2012
W-2 Managing Employee Jan 1, 2012
Crossett Health Foundation Organization, Crossett, AR Operational/Managerial Control Jan 1, 2012 100%
Shirley White Individual Corporate OfficerHR Dir/Accounting Supervisor Jan 1, 2000
Corporate DirectorHR Dir/Accounting Supervisor Jan 1, 2000
W-2 Managing EmployeeHR Dir/Accounting Supervisor Jan 1, 2000

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Ashley County Medical CenterCrossett, AR, CCN 041323 Hospital 5% Or Greater Direct Ownership Interest Aug 1, 1945
Ashley County Medical CenterCrossett, AR, CCN 04Z323 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 1998
Ashley Health ServicesCrossett, AR, CCN 043490 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control (100%)		 Dec 1, 2001
Dec 1, 2001

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 7

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": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1093084808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 W PARKER ST",
            "city": "HAMBURG",
            "state": "AR",
            "postal_code": "716463121",
            "telephone_number": "870-853-8271",
            "fax_number": "870-364-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 W PARKER ST",
            "city": "HAMBURG",
            "state": "AR",
            "postal_code": "716463121",
            "telephone_number": "870-853-8271",
            "fax_number": "870-364-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSETT HEALTH FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSSETT HEALTH FOUNDATION",
        "enumeration_date": "2011-12-22",
        "last_updated": "2013-04-09",
        "status": "A",
        "authorized_official_last_name": "GILMORE",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-364-1271",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163845729",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "54255",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hamburg Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hamburg, AR

Sources for this page

Verify at the official NPI Registry.