NPIMap

Organization Active NPI

Doctors Health Group, Inc

Doing business as Paragould Doctors' Clinic

  • Rural Health Clinic/Center
  • Paragould, AR
National Provider Identifier
1134246747
Registry record updated Aug 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DOCTORS HEALTH GROUP, INC
Doing business as
Paragould Doctors' Clinic
Practice address
4000 Linwood Dr
Suite a
Paragould, AR 72450-7223
Phone
(870) 239-8503
Fax
(870) 236-1947
NPI assigned
Mar 26, 2007
Last updated
Aug 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2014

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

Authorized official

Name
Mr. John Lieblong
Title
Vice President
Phone
(870) 932-7024

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

4000 Linwood Dr
Suite a
Paragould, AR 72450-7223

Mailing address

4000 Linwood Dr
Suite a
Paragould, AR 72450-7223
Phone (870) 239-8503

Other identifiers 1

IdentifierTypeStateIssuer
130182729MedicaidAR

Other names 1

  • Paragould Doctors' Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040720001451 AR Part A Provider - Rural Health Clinic 7315844586 Practice locations: Paragould, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134246747. Details of each certification follow.

Rural health clinic certification: CCN 043822

Legal name
DOCTORS HEALTH GROUP, INC
Doing business as
PARAGOULD DOCTORS' CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 1994
Last certification
Sep 29, 2015
Ownership / control type
1B
Organization structure
OtherNon-profit
Incorporated
Dec 1, 1995 in AR
Enrollment address
4000 Linwood Dr
Ste a
Paragould, AR 72450-7224

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
First Care - Highland Park4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Regional Health Care Holding Inc Organization, Jonesboro, AR 5% Or Greater Direct Ownership Interest Dec 14, 2007
Benjamin Barylske Individual Corporate OfficerTreasurer Mar 1, 2020 100%
Chris Barber Individual Corporate OfficerSecretary Mar 1, 2020 100%
John Lieblong Individual Corporate OfficerPresident Apr 1, 2013 100%
Doctors Health Group, Inc Organization, Jonesboro, AR Corporation 5% Or Greater Direct Ownership Interest Jun 14, 1996 100%
Jakita Lell Individual W-2 Managing EmployeeClinic Administrator Mar 30, 2010 100%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Piggott Family Medical ClinicPiggott, AR, CCN 043834 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 2, 2013

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

  • Doctors Health Group Inc

    dba Piggott Family Medical Clinic

    • Rural Health Clinic/Center
    • Piggott, AR
    • NPI 1326059171

    Doctors Health Group, Inc, Regional Health Care Holding Inc

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1134246747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 LINWOOD DR",
            "address_2": "SUITE A",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724507223",
            "telephone_number": "870-239-8503",
            "fax_number": "870-236-1947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 LINWOOD DR",
            "address_2": "SUITE A",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724507223",
            "telephone_number": "870-239-8503",
            "fax_number": "870-236-1947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS HEALTH GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "LIEBLONG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "870-932-7024",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130182729",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paragould Doctors' Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paragould, AR

Sources for this page

Verify at the official NPI Registry.