NPIMap

Organization Active NPI

River Valley Primary Care Services

  • Community/Retail Pharmacy
  • Ratcliff, AR
National Provider Identifier
1124634555
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
RIVER VALLEY PRIMARY CARE SERVICES
Practice address
9755 W State Highway 22
Ratcliff, AR 72951-9000
Phone
(479) 279-7709
Fax
(479) 974-2044
NPI assigned
Sep 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Authorized official

Name
Jerome J White
Title
Ceo
Phone
(479) 431-2057

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

9755 W State Highway 22
Ratcliff, AR 72951-9000

Mailing address

PO Box 130
Ratcliff, AR 72951-0130
Phone (479) 279-7709

Other names 1

  • RVPCS Community Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210517002287 AR Part B Supplier - Pharmacy 0042274276 5 other NPIs on this enrollment
Practice locations: Bonanza, AR; Coal Hill, AR; Fort Smith, AR; Mountainburg, AR; Mulberry, AR; Ratcliff, AR

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
River Valley Primary Care ServicesWaldron, AR, CCN 041940 Federally qualified health center Operational/Managerial Control (100%) May 1, 2018
Clarksville Behavioral HealthClarksville, AR, CCN 041987 Federally qualified health center 5% Or Greater Indirect Ownership Interest Sep 20, 2021
River Valley Primary Care ServicesCoal Hill, AR, CCN 041000 Federally qualified health center Operational/Managerial Control (100%) Dec 6, 2021

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1124634555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "RATCLIFF",
            "state": "AR",
            "postal_code": "729510130",
            "telephone_number": "479-279-7709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9755 W STATE HIGHWAY 22",
            "city": "RATCLIFF",
            "state": "AR",
            "postal_code": "729519000",
            "telephone_number": "479-279-7709",
            "fax_number": "479-974-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY PRIMARY CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-21",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-431-2057"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RVPCS Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ratcliff, AR

Sources for this page

Verify at the official NPI Registry.