NPIMap

Access Medical Clinic Arkansas LLC

Organization Active NPI Rural Health Clinic/Center · Forrest City, AR

NPI 1104538388 · NPPES record last updated Oct 23, 2023

Key facts

NPI
1104538388
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 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
Organization subpart
No

Authorized official

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

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
    CMS ownership CORPORATE DIRECTOR · OPERATIONAL/MANAGERIAL CONTROL · W-2 MANAGING EMPLOYEE
  • Mark S Hahn, DO Family Medicine Physician · Caraway, AR · NPI 1609895911
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · CORPORATE DIRECTOR

Other NPIs on the same Medicare enrollment 43

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

View all 43

Corporate family (same tax ID) 19

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

Practitioners 37

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

View all 37

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2274126Access Medical Clinic Arkansas LLC
1220 N Washington St, Forrest City, AR 72335		Certificate of waiverDec 26, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AR

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
LLC · Proprietary
Incorporated
Dec 2, 2016 in AR
Enrollment address
1220 N Washington St
Forrest City, AR 72335-2121

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 Director
SVP of Clinic Divisions		 May 15, 2026
W-2 Managing Employee
Ad;		 May 15, 2026
Operational/Managerial Control
SVP of Clinic Divisions		 May 15, 2026
Mark Hahn
Individual 		5% Or Greater Direct Ownership Interest May 8, 2025
Corporate Director
Medical Director		 May 8, 2025
Tony D James
Individual 		Corporate Officer
Cfo		 May 15, 2026
W-2 Managing Employee
Ad;		 May 15, 2026
Jared Clifford
Individual 		Corporate Officer
Ceo		 May 15, 2026
W-2 Managing Employee
Ad;		 May 8, 2025
Monya York
Individual 		Corporate Director
Credentialing Director		 May 8, 2025
W-2 Managing Employee May 8, 2025
Randi L Davis
Individual 		Corporate Director
Sr Director Clinic Operations		 May 15, 2026
W-2 Managing Employee
Ad;		 May 8, 2025
Operational/Managerial Control
Sr Director Clinic Operations		 May 15, 2026
Kasey Crawford
Individual 		Corporate Director
Director Clinic Operations		 May 15, 2026
W-2 Managing Employee
Ad;		 May 15, 2026
Operational/Managerial Control
Director Clinic Operations		 May 15, 2026

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 LLC
Lonoke, AR · CCN 043913		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLC
Weiner, AR · CCN 043885		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLC
Malvern, AR · CCN 043910		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLC
Greenbrier, AR · CCN 043909		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLC
Marshall, AR · CCN 043894		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLC
Perryville, AR · CCN 043898		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLC
Concord, AR · CCN 043891		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas
Cave City, AR · CCN 043915		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023

Medicare enrollment records

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

National Provider Directory

Tax ID family
Access Medical Clinic Arkansas LLC (20 organizations share this tax ID)

Locations

1220 N Washington St
Forrest City, AR 72335
Phone (870) 594-6001

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207Q00000X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

1220 N Washington St
Forrest City, AR 72335-2121

Mailing address

4196 Highway 62 412
Hardy, AR 72542-8002

Other providers in Forrest City, AR

All providers in Forrest City, AR · Rural Health Clinic/Center in Arkansas

Sources for this page

Verify at the official NPI Registry.