NPIMap

Organization Active NPI

Northeast Arkansas Community Mental Health Center Inc

Doing business as Mid South Health Systems, Inc.

  • Community/Behavioral Health Agency
  • Corning, AR
National Provider Identifier
1104077676
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Doing business as
Mid South Health Systems, Inc.
Practice address
602 David St
Corning, AR 72422-7268
Phone
(870) 857-3655
Fax
(870) 972-4911
NPI assigned
Oct 2, 2008
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
Donnie Lyerly
Title
Provider Credentialing
Phone
(870) 972-4939

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

602 David St
Corning, AR 72422-7268

Mailing address

2707 Browns LN
Jonesboro, AR 72401-7213
Phone (870) 972-4939

Other identifiers 1

IdentifierTypeStateIssuer
172106526MedicaidAR

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
Mid-South Health System43 organizations share this tax ID, including this one
Part of
Mid-South Health System

Other organizations with this tax ID 42

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

View all 42

Practitioners & affiliated clinicians

Practitioners 1

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": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1104077676",
    "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",
            "telephone_number": "870-972-4939",
            "fax_number": "870-972-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 DAVID ST",
            "city": "CORNING",
            "state": "AR",
            "postal_code": "724227268",
            "telephone_number": "870-857-3655",
            "fax_number": "870-972-4911"
        }
    ],
    "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": "2008-10-02",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "LYERLY",
        "authorized_official_first_name": "DONNIE",
        "authorized_official_title_or_position": "PROVIDER CREDENTIALING",
        "authorized_official_telephone_number": "870-972-4939"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172106526",
            "state": "AR"
        }
    ],
    "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 Corning, 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.