White River Health System, Inc.
Organization Active NPI Rural Health Clinic/Center · Batesville, AR
NPI 1104275486 · NPPES record last updated May 2, 2024
Key facts
- NPI
- 1104275486
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- WHITE RIVER HEALTH SYSTEM, INC.
- Practice address
- 1217 Batesville Blvd
Batesville, AR 72501-8912 - Phone
- (870) 262-2800
- Fax
- (870) 262-2815
- NPI assigned
- Jun 8, 2016
- Organization subpart
- No
Authorized official
- Name
- Shawna Baxter
- Title
- Provider Enrollment
- Phone
- (870) 262-5545
Other NPIs on the same Medicare enrollment 4
Corporate family (same tax ID) 47
Related certifications (CCN) 16
Facilities with the same owner 16
Practitioners 33
-
Julia L Allen, MD
-
Jennifer Blaney, NP
-
Terry L Burns, MD
-
Amanda B Cooper, APRN, FNP
-
Andy Davidson, MD
-
Birtha V Hartness, ANP
-
Robin Kerr, APN
-
Jeanne Renee' Markowski, APRN
-
Pamela Michelle Mize, APRN
-
Jonathan D Moser, M.D.
-
Robin Lenora Murphy, APRN
-
Sarah Deanne Shaw, APRN-CNP
-
Ronald W Simpson, MD
-
Kathryn Tharp, FNP-BC
-
Robert B Walton, MD
-
Brooke Nicole Whitt, FNP-C
-
Sarah Lynn Wycough, APRN
-
Jennifer Tosh, APRN
-
Beverly Kay Caraway, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2119423 | White River Health Family Care | Compliance | Aug 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Rural health clinic certification: CCN 048541
- Legal name
- WHITE RIVER HEALTH SYSTEM, INC.
- Doing business as
- WHITE RIVER HEALTH FAMILY CARE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 22, 2023
- Last certification
- Aug 22, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 17, 1999 in AR
- Enrollment address
- 1217 Batesville Blvd
Southside, AR 72501-8912 - Related CCNs
- 040119
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Crystal Johnson |
Corporate Officer |
Jan 1, 2026 | |
| White River Health System, Inc. |
5% Or Greater Direct Ownership Interest | Feb 1, 2023 | 100% |
| Stacy Gunderman |
Corporate Officer |
Jan 1, 2026 | |
| Maggie Williams |
Corporate Director |
Nov 1, 2025 | |
| Danny Bell |
Corporate Officer |
Jan 1, 2026 | |
| Robert McIntire |
Corporate Officer |
Jan 1, 2026 | |
| Elizabeth Christian |
Corporate Officer |
Jan 1, 2026 | |
| Jason Taylor |
Corporate Officer |
Jan 1, 2026 | |
| Tina Wheelis |
Corporate Officer |
Jan 1, 2026 | |
| Shawna Baxter |
W-2 Managing Employee |
Aug 28, 2023 | |
| Kevin S Rose |
Corporate Officer |
Jan 1, 2026 | |
| Randy Cross |
Corporate Officer |
Jan 1, 2026 | |
| Kathy Lanier |
Corporate Officer |
Jan 1, 2026 | |
| Lisa Lambert |
Corporate Director |
Jan 1, 2013 | |
| William Tyler Fowlkes |
Corporate Officer |
Jan 1, 2026 | |
| Lance Lamberth |
Corporate Officer |
Jan 1, 2026 |
All facility ownership & control disclosures 16
| Facility | Type | Role | Since |
|---|---|---|---|
| White River Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 31, 1976 Jan 31, 1976 |
| Stone County Medical Center |
Hospital | Operational/Managerial Control | Jan 1, 2008 |
| Stone County Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest | Apr 1, 1999 |
| White River Medical Center |
Hospital | Operational/Managerial Control | Dec 21, 2007 |
| White River Medical Center Rehabilitation Unit |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1976 |
| Midway Medical Clinic |
Rural health clinic | Operational/Managerial Control (100%) | Sep 10, 2010 |
| Melbourne Medical Clinic |
Rural health clinic | Operational/Managerial Control | Oct 16, 2007 |
| Drasco Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jul 12, 1996 |
| Cave City Medical Clinic |
Rural health clinic | Operational/Managerial Control | Nov 19, 1991 |
| Plesant Plains Medical Clinic |
Rural health clinic | Operational/Managerial Control | Jul 1, 2006 |
| White River Health Family Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2015 |
| Sugarloaf Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2021 |
| White River Health Family Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| White River Health Family Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| White River Health Care Family |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2023 |
| White River Health Children'S Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170119000552 | AR | Part B Supplier - Clinic/Group Practice | 0143134270 |
Receives reassigned benefits from 24 practitioners 4 other NPIs on this enrollment Practice locations: Southside, AR |
| O20230327002978 | AR | Part a Provider - Rural Health Clinic | 0143134270 | Practice locations: Southside, AR |
National Provider Directory
- Tax ID family
- White Riv HLTH Syst Inc
Locations
501 Vine St
Newark, AR 72562
Phone (870) 799-3299
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1217 Batesville Blvd
Batesville, AR 72501-8912
Mailing address
1710 Harrison St
Batesville, AR 72501-7303
Phone (870) 262-2800
Other names
- WHITE RIVER HEALTH FAMILY CARE
Other providers in Batesville, AR
- White River Health System, Inc
- White River Health System, Inc
- White River Health System, Inc.
- White River Health System, Inc.
- White River Health System, Inc.
- White River Health System, Inc.
- White River Health System, Inc.
- White River Health System, Inc.
- White River Health System, Inc.
- White River Health System, Inc.
All providers in Batesville, AR · Rural Health Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.