NPIMap

Organization Active NPI

Jefferson Hospital Association, Inc

  • Family Medicine Physician
  • Monticello, AR
National Provider Identifier
1104587526
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JEFFERSON HOSPITAL ASSOCIATION, INC
Practice address
906 Roberts Drive
Suite B
Monticello, AR 71655-5724
Phone
(870) 367-1461
NPI assigned
Jan 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

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

Authorized official

Name
Shayla Robinson
Title
Corporate Compliance Officer
Phone
(870) 541-7395

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

906 Roberts Drive
Suite B
Monticello, AR 71655-5724

Mailing address

PO Box 2650
Pine Bluff, AR 71613-2650

Other names 1

  • Jefferson Regional Monticello Medical Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040106000512 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 105 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pine Bluff, AR; Sheridan, AR; Star City, AR; Stuttgart, AR; Warren, AR; White Hall, AR; Crossett, AR; De Witt, AR…

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

1194 N Chester St
Monticello, AR 71655
Phone (870) 367-6852

906 Roberts Dr
Monticello, AR 71655
Phone (870) 367-6867

1601 W 40th Ave
Ste 301C
Pine Bluff, AR 71603
Phone (870) 541-6060

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648771200000",
    "number": "1104587526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716132650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 ROBERTS DRIVE",
            "address_2": "SUITE B",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716555724",
            "telephone_number": "870-367-1461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-07",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "SHAYLA",
        "authorized_official_title_or_position": "CORPORATE COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "870-541-7395"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Regional Monticello Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Monticello, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.