Access Medical Clinic Arkansas LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ACCESS MEDICAL CLINIC ARKANSAS LLC

Practice address

104 W State St
Caraway, AR 72419

Phone

(870) 956-0200

Fax

(870) 895-2164

NPI assigned

Mar 26, 2018

Last updated

Feb 3, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

ACCESS MEDICAL CLINIC ARKANSAS LLCAs reported in NPPES

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

Authorized official

Name

Bradley Ray BibbNPI 1700824307

Title

Ceo

Phone

(870) 994-7301

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104321850. Details of each certification follow.

• CCN 043899 Rural health clinic · Active · Details

Rural health clinic certification: CCN 043899

Legal name

ACCESS MEDICAL CLINIC ARKANSAS LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 27, 2018

Last certification

Aug 27, 2018

Ownership / control type

1C

Organization structure

LLCProprietary

Incorporated

Dec 2, 2016 in AR

Enrollment address

104 W State St
Caraway, AR 72419-8553

Other NPIs on the same Medicare enrollment 43

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

• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Lamar, AR
  • NPI 1073004891

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Forrest City, AR
  • NPI 1104538388

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Family Medicine Physician
  • Salem, AR
  • NPI 1124657713

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Garfield, AR
  • NPI 1144755570

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Cedarville, AR
  • NPI 1164913984

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Searcy, AR
  • NPI 1174235964

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Flippin, AR
  • NPI 1184163008

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Osceola, AR
  • NPI 1184401325

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Blytheville, AR
  • NPI 1245017870

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  dba Access Medical Podiatry

  • Podiatrist
  • Booneville, AR
  • NPI 1255910782

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Clarksville, AR
  • NPI 1265127591

  O20170124001288

  Same enrollment
• Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Booneville, AR
  • NPI 1285150672

  O20170124001288

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Access Medical Clinic Arkansas LLC

All disclosed owners & managing parties 7

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

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Randi L Davis, APRN

  • Family Nurse Practitioner
  • Bay, AR
  • NPI 1740622497

  Corporate Director, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership
• Mark S Hahn, DO

  • Family Medicine Physician
  • Caraway, AR
  • NPI 1609895911

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership

All facility ownership & control disclosures 8

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

Practitioners 6

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.

• Bradley Ray Bibb, MD

  • Family Medicine Physician
  • Ash Flat, AR
  • NPI 1700824307
  Authorized official Same address or phone
• Gina Marie Morgan, D.P.M.

  • Podiatrist
  • Benton, AR
  • NPI 1093949448

  Single Specialty

  NPD
• Bilal Naeem, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Springdale, AR
  • NPI 1316901994
  NPD
• David Starnes, PA

  • Physician Assistant
  • Batesville, AR
  • NPI 1851470231
  NPD
• Bridget Diane Reyes, APRN

  • Family Nurse Practitioner
  • Hot Springs, AR
  • NPI 1932808987
  NPD (past)
• Aubrey Wilson, LCSW

  • Clinical Social Worker
  • Mountain Home, AR
  • NPI 1982058723
  NPD (past)

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1104321850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W MAIN ST",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725429566",
            "telephone_number": "573-718-2570",
            "fax_number": "870-856-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W STATE ST",
            "city": "CARAWAY",
            "state": "AR",
            "postal_code": "72419",
            "telephone_number": "870-956-0200",
            "fax_number": "870-895-2164"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 West State Street",
            "address_purpose": "LOCATION",
            "city": "Caraway",
            "state": "AR",
            "postal_code": "72419",
            "country_code": "US",
            "telephone_number": "870-994-7301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ACCESS MEDICAL CLINIC ARKANSAS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ACCESS MEDICAL CLINIC ARKANSAS LLC",
        "enumeration_date": "2018-03-26",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "BIBB",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-994-7301"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donasha Blair
• Leslie M Brown, APRN
• Caraway Drug L.L.C (Caraway Drug)
• Erin Elizabeth Clay, MCD, CCC-SLP
• Riley Carlton Wade Grogan

• Rural Health Clinic/Center in Caraway, AR
• Providers in Caraway, 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 Feb 3, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.