NPIMap

Organization Active NPI

John Ed Chambers Memorial Hospital, Inc.

  • Emergency Care Clinic/Center
  • Danville, AR
National Provider Identifier
1154358307
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Care Clinic/CenterTaxonomy code 261QE0002X
License
AR4293 Issued in AR
Legal business name
JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.
Practice address
719 Detroit Ave
Danville, AR 72833-9607
Phone
(479) 495-2241
Fax
(479) 495-6290
NPI assigned
Jun 26, 2006
Last updated
Sep 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Authorized official

Name
Michael Scott Peek
Title
Ceo
Phone
(479) 495-2241

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Care Clinic/Center 261QE0002X AR4293 AR Primary

Addresses

Primary practice location

719 Detroit Ave
Danville, AR 72833-9607

Mailing address

PO Box 639
Danville, AR 72833-0639
Phone (479) 495-2241

Other identifiers 2

IdentifierTypeStateIssuer
113073002MedicaidAR
57988OtherARBLUE CROSS PROV. NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050308000661 AR Part B Supplier - Clinic/Group Practice 4688628167 Receives reassigned benefits from 17 practitioners
4 other NPIs on this enrollment
Practice locations: Danville, AR; Plainview, AR; Havana, AR; Ola, AR

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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
Chambers Memorial HospitalDanville, AR, CCN 040011 Hospital Operational/Managerial Control (100%) Jun 1, 2021
Chambers Memorial HospitalDanville, AR, CCN 04U011 Hospital Operational/Managerial Control (100%) Jun 1, 2021
Chambers Memorial Hospital Home HealthDanville, AR, CCN 047096 Home health agency Operational/Managerial Control (100%) Jun 1, 2021

Owned or controlled facilities with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1154358307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "DANVILLE",
            "state": "AR",
            "postal_code": "728330639",
            "telephone_number": "479-495-2241",
            "fax_number": "479-495-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 DETROIT AVE",
            "city": "DANVILLE",
            "state": "AR",
            "postal_code": "728339607",
            "telephone_number": "479-495-2241",
            "fax_number": "479-495-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "PEEK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-495-2241"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "AR",
            "license": "AR4293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113073002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROV. NUMBER",
            "identifier": "57988",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, AR

Sources for this page

Verify at the official NPI Registry.