NPIMap

Organization Active NPI

Howard Memorial Hospital

  • Clinical Neuropsychologist
  • Nashville, AR
National Provider Identifier
1104282664
Registry record updated Jan 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
E-5611 Issued in AR
Legal business name
HOWARD MEMORIAL HOSPITAL
Practice address
122 Medical Cir
Nashville, AR 71852-8606
Phone
(870) 845-6069
Fax
(845) 845-6068
NPI assigned
Jan 13, 2016
Organization subpart
Yes
Parent organization
HOWARD MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2016

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

Authorized official

Name
Mrs. Judy Ann Kosters
Title
Business Office Director
Phone
(870) 845-8024

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X E-5611 AR Primary

Addresses

Primary practice location

122 Medical Cir
Nashville, AR 71852-8606

Mailing address

130 Medical Cir
Nashville, AR 71852-8606
Phone (870) 845-8024

Other identifiers 1

IdentifierTypeStateIssuer
AR4577OtherARHOSPITAL LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160607001354 AR Part B Supplier - Clinic/Group Practice 7315851599 Receives reassigned benefits from 3 practitioners
Practice locations: Nashville, AR

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Howard Memorial Hospita10 organizations share this tax ID, including this one
Part of
Howard Memorial Hospita

Other organizations with this tax ID 9

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

Locations

130 Medical Cir
Nashville, AR 71852
Phone (501) 624-7700

122 Medical Cir
Nashville, AR 71852
Phone (870) 845-6069

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/howard-9d20da0d

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Elite Home HealthNashville, AR, CCN 047138 Home health agency 5% Or Greater Direct Ownership Interest (33%) Jul 16, 2007

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452643200000",
    "number": "1104282664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 MEDICAL CIR",
            "city": "NASHVILLE",
            "state": "AR",
            "postal_code": "718528606",
            "telephone_number": "870-845-8024",
            "fax_number": "870-845-8027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 MEDICAL CIR",
            "city": "NASHVILLE",
            "state": "AR",
            "postal_code": "718528606",
            "telephone_number": "870-845-6069",
            "fax_number": "845-845-6068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOWARD MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOWARD MEMORIAL HOSPITAL",
        "enumeration_date": "2016-01-13",
        "last_updated": "2016-01-13",
        "status": "A",
        "authorized_official_last_name": "KOSTERS",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "870-845-8024",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "AR",
            "license": "E-5611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITAL LICENSE",
            "identifier": "AR4577",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, AR

Sources for this page

Verify at the official NPI Registry.