NPIMap

Organization Active NPI

Access Medical Clinic Arkansas LTC LLC

  • Rural Health Clinic/Center
  • Perryville, AR
National Provider Identifier
1124539648
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
Practice address
1016 North Fourche Avenue
Perryville, AR 72126
Phone
(501) 238-1284
NPI assigned
Oct 24, 2017
Last updated
Oct 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1016 North Fourche Avenue
Perryville, AR 72126

Mailing address

101 W Main St
Hardy, AR 72542-9566
Phone (573) 718-2570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR3 enrollments

Enrollment records 3

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…
O20231204002547 AR Part A Provider - Rural Health Clinic 0547618175 Practice locations: Perryville, AR
O20231208000065 AR Part B Supplier - Clinic/Group Practice 0547618175 Receives reassigned benefits from 126 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Malvern, AR; Weiner, AR; Perryville, AR; Marshall, AR; Lonoke, AR; Greenbrier, AR; Concord, AR; Cave City, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124539648. Details of each certification follow.

Rural health clinic certification: CCN 043898

Legal name
ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 2, 2018
Last certification
Jun 2, 2018
Ownership / control type
1C
Most recent change of ownership
Jan 1, 2024 (1 total)
Organization structure
LLCProprietary
Incorporated
Jul 24, 2023 in AR
Enrollment address
1016 N Fourche Ave
Perryville, AR 72126-8545

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 44

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

View all 44

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

11005 Heber Springs Rd N
Concord, AR 72523
Phone (844) 291-4901

Ownership & related parties

All disclosed owners & managing parties 8

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 Clinics Operation May 19, 2026
W-2 Managing EmployeeAd; May 19, 2026
Operational/Managerial ControlSVP of Clinics Operation May 19, 2026
Mark Hahn Individual 5% Or Greater Indirect Ownership Interest May 8, 2025 100%
Corporate DirectorMedical Director May 8, 2025
Tony D James Individual Corporate OfficerCfo May 19, 2026
W-2 Managing EmployeeAd; May 19, 2026
Jared Clifford Individual Corporate OfficerCeo May 19, 2026
W-2 Managing EmployeeAd; May 8, 2025
Access Medical Clinic Arkansas LLC Organization, Hardy, AR LLC 5% Or Greater Direct Ownership Interest Jul 24, 2023 100%
Monya York Individual Corporate DirectorCredentialing Manager May 8, 2025
W-2 Managing Employee May 8, 2025
Randi L Davis Individual Corporate DirectorSr Director Clinic Operations May 19, 2026
W-2 Managing EmployeeAd; May 8, 2025
Operational/Managerial ControlSr Director Clinic Operations May 19, 2026
Kasey Crawford Individual Corporate DirectorDirector Clinic Operations May 19, 2025
W-2 Managing EmployeeAd; May 19, 2026
Operational/Managerial ControlDirector Clinic Operations May 19, 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 Indirect Ownership Interest, Corporate Director

    CMS ownership

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 2

DateEventCounterparty
Jan 1, 2024 Change of OwnershipThis provider was the buyer Access Medical Clinic Arkansas LLCCCN 043898, AR, NPI 1124539648
Jan 1, 2024 Change of OwnershipThis provider was the seller Access Medical Clinic Arkansas LTC LLCCCN 043898, AR, NPI 1124539648

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1124539648",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 NORTH FOURCHE AVENUE",
            "city": "PERRYVILLE",
            "state": "AR",
            "postal_code": "72126",
            "telephone_number": "501-238-1284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS MEDICAL CLINIC ARKANSAS LTC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-24",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perryville, AR

Sources for this page

Verify at the official NPI Registry.