NPIMap

Organization Active NPI

CHI St. Vincent Medical Group Hot Springs

  • Rural Health Clinic/Center
  • Glenwood, AR
National Provider Identifier
1154651982
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHI ST. VINCENT MEDICAL GROUP HOT SPRINGS
Practice address
234 E Broadway
Glenwood, AR 71943-9243
Phone
(870) 356-4821
Fax
(870) 356-4721
NPI assigned
Dec 29, 2009
Last updated
Mar 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

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

Authorized official

Name
Mr. Shawn Barnett
Title
Cfo
Phone
(501) 609-2229

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

234 E Broadway
Glenwood, AR 71943-9243

Mailing address

PO Box 21850
Hot Springs, AR 71903-1850
Phone (501) 627-1800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100301000773 AR Part A Provider - Rural Health Clinic 3971673716 Practice locations: Glenwood, AR
O20100918000105 AR Part B Supplier - Clinic/Group Practice 3971673716 Receives reassigned benefits from 16 practitioners
Practice locations: Glenwood, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154651982. Details of each certification follow.

Rural health clinic certification: CCN 043868

Legal name
CHI ST VINCENT MEDICAL GROUP HOT SPRINGS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 8, 2010
Last certification
Dec 6, 2016
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 2008 in AR
Enrollment address
234 Broadway, Mercy Clinic Hot Springs Communities
Glenwood, AR 71943-9243

Other NPIs with the same Medicare PAC ID 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D0928094CHI St Vincent Medical Group Hot Springs234 Broadway, Glenwood, AR 71943ComplianceJan 23, 2027

National Provider Directory

National Provider Directory

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
CHI St Vincent Hot Springs Organization, Hot Springs, AR Non-profit 5% Or Greater Indirect Ownership Interest Jul 8, 2010 100%
Commonspirit Health Organization, Englewood, CO Non-profit 5% Or Greater Indirect Ownership Interest Apr 1, 2014 100%
Patricia M Jones Individual W-2 Managing EmployeeDirector of Finance Apr 1, 2014
Michael Bodemann Individual Corporate DirectorBoard Member Mar 1, 2008 9%
Seth a Hollenbach Individual Corporate DirectorBoard Member Jul 1, 2018
Ashley T Jenkins Individual Corporate DirectorMember May 14, 2021
Thomas H Hollis Individual Corporate DirectorBoard Member Oct 1, 2013 9%
Lawrence Dodd Individual Corporate DirectorBoard Member Jul 1, 2018
Jeffrey Miller Individual Corporate DirectorBoard Member Jul 1, 2018
Amy Gordon Individual Corporate DirectorMember May 14, 2021
St Vincent Infirmary Medical Center Organization, Little Rock, AR Non-profit 5% Or Greater Indirect Ownership Interest Apr 1, 2014 100%
Seth M Barnes Individual Corporate DirectorMember May 14, 2021
Patrick Kennedy Individual Corporate DirectorBoard Member Jul 1, 2018
Zachary S Larrimer Individual Corporate DirectorMember May 14, 2021
Shawn Barnett Individual Corporate DirectorCfo Mar 19, 2018
W-2 Managing EmployeeCfo Mar 19, 2018
Theresa Polk Individual W-2 Managing Employee Apr 1, 2014

Owners & managing parties with NPI records 12

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1262044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583107200000",
    "number": "1154651982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21850",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719031850",
            "telephone_number": "501-627-1800",
            "fax_number": "501-627-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 E BROADWAY",
            "city": "GLENWOOD",
            "state": "AR",
            "postal_code": "719439243",
            "telephone_number": "870-356-4821",
            "fax_number": "870-356-4721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHI ST. VINCENT MEDICAL GROUP HOT SPRINGS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-29",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A",
        "authorized_official_last_name": "BARNETT",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "501-609-2229",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal 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 Glenwood, AR

Sources for this page

Verify at the official NPI Registry.