NPIMap

Organization Active NPI

St Bernard Community Hospital Corporation

  • Critical Access Hospital
  • Wynne, AR
National Provider Identifier
1114937174
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
AR4063 Issued in AR
Legal business name
ST BERNARD COMMUNITY HOSPITAL CORPORATION
Practice address
310 Falls Blvd S
Wynne, AR 72396-3013
Phone
(870) 238-3300
Fax
(870) 238-7432
NPI assigned
Aug 9, 2006
Last updated
Sep 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Bryan Scott Mattes
Title
Associate Administrator
Phone
(870) 208-2145

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X AR4063 AR Primary

Addresses

Primary practice location

310 Falls Blvd S
Wynne, AR 72396-3013

Mailing address

PO Box 590
Wynne, AR 72396-0590
Phone (870) 238-3300

Other identifiers 2

IdentifierTypeStateIssuer
56847OtherARBLUE CROSS PROF FEES
145193002MedicaidAR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Cross.Ridge@cr.hin.us Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040110000022 AR Part B Supplier - Clinic/Group Practice 7810897485 Receives reassigned benefits from 31 practitioners
Practice locations: Wynne, AR

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
St Bernard Comm Hosp Corp5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

310 Falls Blvd S
Wynne, AR 72396
Phone (870) 208-2151

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1114937174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 590",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723960590",
            "telephone_number": "870-238-3300",
            "fax_number": "870-238-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 FALLS BLVD S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963013",
            "telephone_number": "870-238-3300",
            "fax_number": "870-238-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST BERNARD COMMUNITY HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "MATTES",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "ASSOCIATE ADMINISTRATOR",
        "authorized_official_telephone_number": "870-208-2145"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AR",
            "license": "AR4063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROF FEES",
            "identifier": "56847",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145193002",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Cross.Ridge@cr.hin.us",
            "affiliation": "N",
            "endpointDescription": "direct email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct emial",
            "address_1": "310 Falls Blvd S",
            "city": "Wynne",
            "state": "AR",
            "country_code": "US",
            "postal_code": "723963013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wynne, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.