NPIMap

Organization Active NPI

Conway Regional Medical Center Inc

Doing business as Conway Regional HomeCare Services

  • Home Health Agency
  • Conway, AR
National Provider Identifier
1154340552
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
4068 Issued in AR
Legal business name
CONWAY REGIONAL MEDICAL CENTER INC
Doing business as
Conway Regional HomeCare Services
Practice address
2843 Prince St
Conway, AR 72034-3637
Phone
(501) 329-9377
Fax
(501) 329-0724
NPI assigned
Jul 18, 2006
Last updated
Sep 4, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CONWAY REGIONAL MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Authorized official

Name
William Pack
Title
Cfo
Phone
(501) 450-2112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 4068 AR Primary

Addresses

Primary practice location

2843 Prince St
Conway, AR 72034-3637

Mailing address

2843 Prince St
Conway, AR 72034-3637
Phone (501) 329-9377

Other names 1

  • Conway Regional HomeCare Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081024000631 AR Part A Provider - Home Health Agency 3173428414 Practice locations: Conway, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154340552. Details of each certification follow.

Home health agency certification: CCN 047083

Legal name
CONWAY REGIONAL MEDICAL CENTER INC
Doing business as
CONWAY REGIONAL HOME HEALTH SERVICES
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 6, 1984
Last certification
Feb 7, 2019
Ownership / control type
Proprietary
Organization structure
CorporationNon-profit
Enrollment address
2843 Prince Street
Conway, AR 72034-3637
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Conway Regional Homecare SVCSCCN 047083 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Mar 6, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Conway Reg Med Ctr Inc15 organizations share this tax ID, including this one
Part of
Conway Reg Med Ctr Inc

Other organizations with this tax ID 14

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

View all 14

Locations

2134 Robinson Ave
Conway, AR 72034
Phone (501) 329-9377

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Allison Bramlett Individual W-2 Managing EmployeeCredentialer Jul 18, 2023
Susan Gatto Individual Corporate DirectorBoard Member Jan 1, 2022
Carter Dodd Individual Corporate DirectorAssociate Administrator Apr 1, 2021
Jim Rankin Individual Corporate DirectorBoard Member Jan 1, 2012
William Pack Individual Corporate DirectorCfo Aug 29, 2022
W-2 Managing EmployeeCfo Aug 29, 2022
Matthew Troup Individual Contracted Managing EmployeeCeo Sep 15, 2015
Operational/Managerial ControlCeo Sep 15, 2015
Rebekah Fincher Individual Corporate DirectorChief Administrative Officer Jan 1, 2023
W-2 Managing EmployeeChief Administrative Officer Jan 1, 2023
Thad R Hardin Individual Corporate DirectorBoard Member Jan 1, 2017
Jeffrey Standridge Individual Corporate DirectorBoard Member Jan 1, 2017
Tom Poe Individual Corporate DirectorBoard Member Jan 1, 2013
Gena Ester Individual Corporate DirectorBoard Member Jan 1, 2022
Andrew Cole Individual Corporate DirectorBoard Member Jan 1, 2012
Wayne Cox Individual Corporate DirectorBoard Member Jan 1, 2013
Sindee Morse Individual Corporate Director Nov 20, 2022
Operational/Managerial Control Nov 20, 2022
Bryan Bruich Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Conway Regional Rehabilitation Hospital LLCConway, AR, CCN 043033 Hospital 5% Or Greater Direct Ownership Interest (69.6%) Apr 6, 2004
Dardanelle Regional Medical CenterDardanelle, AR, CCN 04Z302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2022
Dardanelle Regional Medical CenterDardanelle, AR, CCN 04M302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2022
Dardanelle Regional Medical CenterDardanelle, AR, CCN 041302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2022
Conway Regional Medical Clinic - ViloniaVilonia, AR, CCN 048536 Rural health clinic Operational/Managerial Control (100%) Dec 11, 2014
Greenbrier Family MedicineGreenbrier, AR, CCN 048534 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 25, 2004
Oct 25, 2004
Mayflower Medical ClinicMayflower, AR, CCN 048537 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 25, 2004
Clinton Medical ClinicClinton, AR, CCN 048563 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 25, 2004

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 38

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1154340552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2843 PRINCE ST",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720343637",
            "telephone_number": "501-329-9377",
            "fax_number": "501-329-0724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2843 PRINCE ST",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720343637",
            "telephone_number": "501-329-9377",
            "fax_number": "501-329-0724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONWAY REGIONAL MEDICAL CENTER INC",
        "enumeration_date": "2006-07-18",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "PACK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "501-450-2112"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AR",
            "license": "4068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conway Regional HomeCare Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.