NPIMap

Organization Active NPI

Reach Behavioral Health

  • Clinical Social Worker
  • Benton, AR
National Provider Identifier
1093379935
Registry record updated Apr 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
REACH BEHAVIORAL HEALTH
Practice address
17724 Interstate 30 N
Benton, AR 72019-2907
Phone
(501) 580-3124
NPI assigned
Apr 25, 2019
Last updated
Apr 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2019

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

Authorized official

Name
Penny Jester
Title
Ceo
Phone
(501) 580-3124

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

17724 Interstate 30 N
Benton, AR 72019-2907

Mailing address

17706 Interstate 30 N
Benton, AR 72019-2907
Phone (501) 580-3124

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pjester@kidsourcetherapy.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200417000624 AR Part B Supplier - Clinic/Group Practice 6103256052 Receives reassigned benefits from 6 practitioners
Practice locations: Benton, AR; Little Rock, AR

National Provider Directory

National Provider Directory

Locations

17680 Interstate 30 N
Ste 1
Benton, AR 72019
Phone (501) 575-2344

300 S Rodney Parham Rd
Ste 12
Little Rock, AR 72205
Phone (501) 575-2344

300 S Rodney Parham Rd
Ste 13
Little Rock, AR 72205

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556150400000",
    "number": "1093379935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17706 INTERSTATE 30 N",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720192907",
            "telephone_number": "501-580-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17724 INTERSTATE 30 N",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720192907",
            "telephone_number": "501-580-3124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REACH BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-25",
        "last_updated": "2019-04-25",
        "status": "A",
        "authorized_official_last_name": "JESTER",
        "authorized_official_first_name": "PENNY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "501-580-3124"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pjester@kidsourcetherapy.com",
            "affiliation": "N",
            "address_1": "17724 Interstate 30 N",
            "city": "Benton",
            "state": "AR",
            "country_code": "US",
            "postal_code": "720192907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; 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.