NPIMap

Organization Active NPI

Baxter Regional Health System

Doing business as Baxter Health Family Clinic at Melbourne

  • Family Nurse Practitioner
  • Melbourne, AR
National Provider Identifier
1154849065
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
BAXTER REGIONAL HEALTH SYSTEM
Doing business as
Baxter Health Family Clinic at Melbourne
Practice address
1019 East Main Street
Melbourne, AR 72556
Phone
(870) 916-2150
NPI assigned
Aug 31, 2017
Last updated
May 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

Name
Debra Henry
Title
Cfo
Phone
(870) 508-1003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

1019 East Main Street
Melbourne, AR 72556

Mailing address

1019 East Main Street
Melbourne, AR 72556
Phone (870) 916-2150

Other names 1

  • Baxter Health Family Clinic at Melbourne Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160324000353 AR Part B Supplier - Clinic/Group Practice 0941507677 Receives reassigned benefits from 20 practitioners
8 other NPIs on this enrollment
Practice locations: Melbourne, AR; Harrison, AR; Mountain Home, AR; Mountain View, AR; Pocahontas, AR; Salem, AR; Mammoth Spring, AR; Cave City, AR…

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Baxter Regional Health System8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the 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
Baxter Health Fulton County HospitalSalem, AR, CCN 041322 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 31, 2024
Dec 31, 2024
Baxter HealthSalem, AR, CCN 04Z322 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 31, 2024
Dec 31, 2024
Baxter Health Fulton County Family ClinicSalem, AR, CCN 048552 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025

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 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": "1504137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1154849065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 EAST MAIN STREET",
            "city": "MELBOURNE",
            "state": "AR",
            "postal_code": "72556",
            "telephone_number": "870-916-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 EAST MAIN STREET",
            "city": "MELBOURNE",
            "state": "AR",
            "postal_code": "72556",
            "telephone_number": "870-916-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAXTER REGIONAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-31",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-508-1003"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baxter Health Family Clinic at Melbourne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, AR

Sources for this page

Verify at the official NPI Registry.