NPIMap

Organization Active NPI

Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Forrest City, AR
National Provider Identifier
1104538388
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACCESS MEDICAL CLINIC ARKANSAS LLC
Practice address
1220 N Washington St
Forrest City, AR 72335-2121
Phone
(870) 594-6001
Fax
(501) 823-3623
NPI assigned
Dec 19, 2022
Last updated
Oct 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Authorized official

Name
Monya York
Title
Controller
Phone
(870) 856-1202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

1220 N Washington St
Forrest City, AR 72335-2121

Mailing address

4196 Highway 62 412
Hardy, AR 72542-8002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170124001288 AR Part B Supplier - Clinic/Group Practice 5890077093 Receives reassigned benefits from 171 practitioners
43 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Heber Springs, AR; Hope, AR; Lamar, AR; Mena, AR; Mountain Home, AR; Newport, AR; Osceola, AR; Ozark, AR…
O20230420002712 AR Part A Provider - Rural Health Clinic 5890077093 Practice locations: Forrest City, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104538388. Details of each certification follow.

Rural health clinic certification: CCN 043927

Legal name
ACCESS MEDICAL CLINIC ARKANSAS LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 13, 2023
Last certification
Aug 13, 2023
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Dec 2, 2016 in AR
Enrollment address
1220 N Washington St
Forrest City, AR 72335-2121

Other NPIs on the same Medicare enrollment 43

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

View all 43

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2274126Access Medical Clinic Arkansas LLC1220 N Washington St, Forrest City, AR 72335Certificate of waiverDec 26, 2026

National Provider Directory

National Provider Directory
Tax ID family
Access Medical Clinic Arkansas LLC20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

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.

NameRoleSinceShare
Howard Freeman Individual Corporate DirectorSVP of Clinic Divisions May 15, 2026
W-2 Managing EmployeeAd; May 15, 2026
Operational/Managerial ControlSVP of Clinic Divisions May 15, 2026
Mark Hahn Individual 5% Or Greater Direct Ownership Interest May 8, 2025
Corporate DirectorMedical Director May 8, 2025
Tony D James Individual Corporate OfficerCfo May 15, 2026
W-2 Managing EmployeeAd; May 15, 2026
Jared Clifford Individual Corporate OfficerCeo May 15, 2026
W-2 Managing EmployeeAd; May 8, 2025
Monya York Individual Corporate DirectorCredentialing Director May 8, 2025
W-2 Managing Employee May 8, 2025
Randi L Davis Individual Corporate DirectorSr Director Clinic Operations May 15, 2026
W-2 Managing EmployeeAd; May 8, 2025
Operational/Managerial ControlSr Director Clinic Operations May 15, 2026
Kasey Crawford Individual Corporate DirectorDirector Clinic Operations May 15, 2026
W-2 Managing EmployeeAd; May 15, 2026
Operational/Managerial ControlDirector Clinic Operations May 15, 2026

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.

FacilityTypeRoleSince
Access Medical Clinic Arkansas LTC LLCLonoke, AR, CCN 043913 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCWeiner, AR, CCN 043885 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCMalvern, AR, CCN 043910 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCGreenbrier, AR, CCN 043909 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCMarshall, AR, CCN 043894 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCPerryville, AR, CCN 043898 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCConcord, AR, CCN 043891 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic ArkansasCave City, AR, CCN 043915 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023

Practitioners & affiliated clinicians

Practitioners 37

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.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1104538388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 N WASHINGTON ST",
            "city": "FORREST CITY",
            "state": "AR",
            "postal_code": "723352121",
            "telephone_number": "870-594-6001",
            "fax_number": "501-823-3623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS MEDICAL CLINIC ARKANSAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-19",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "MONYA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "870-856-1202"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forrest City, AR

Sources for this page

Verify at the official NPI Registry.