Baptist Health

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

BAPTIST HEALTH

Practice address

10 Montgomery Drive
Caddo Valley, AR 71923

Phone

(870) 245-2198

NPI assigned

Aug 13, 2014

Last updated

Sep 18, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Troy Wells

Title

President

Phone

(501) 202-2080

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104235332. Details of each certification follow.

• CCN 048507 Rural health clinic · Active · Details

Rural health clinic certification: CCN 048507

Legal name

BAPTIST HEALTH

Doing business as

BAPTIST HEALTH FAMILY CLINIC - CADDO VALLEY

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 5, 2014

Last certification

Nov 1, 2023

Ownership / control type

2B

Organization structure

CorporationNon-profit

Incorporated

Oct 1, 1920 in AR

Enrollment address

10 Montgomery Dr
BHFC Caddo Valley
Caddo Valley, AR 71923-8901

Related CCNs

041321

Related certifications (CCN) 1

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

• Baptist Health

  dba Baptist Health Medical Center-Arkadelphia

  • Critical Access Hospital
  • Arkadelphia, AR
  • NPI 1174553796

  Parent provider

  Provider of Services

Other NPIs on the same Medicare enrollment 1

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

• Baptist Health

  dba Baptist Health Family Clinic - Caddo Valley

  • Rural Health Clinic/Center
  • Caddo Valley, AR
  • NPI 1528478955

  O20140825001220

  Same enrollment

All disclosed owners & managing parties 20

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

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442534400000",
    "number": "1104235332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MONTGOMERY DRIVE",
            "city": "CADDO VALLEY",
            "state": "AR",
            "postal_code": "71923",
            "telephone_number": "870-245-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MONTGOMERY DRIVE",
            "city": "CADDO VALLEY",
            "state": "AR",
            "postal_code": "71923",
            "telephone_number": "870-245-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-13",
        "last_updated": "2015-09-18",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-202-2080"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Baptist Health (Baptist Health Family Clinic - Caddo Valley)
• Amber Dawn Jones, FNP-MSN-BC

• Rural Health Clinic/Center in Caddo Valley, AR
• Providers in Caddo Valley, AR by specialty
• Rural Health Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.