NPIMap

Organization Active NPI

Bradley County Medical Center

Doing business as Bradley County Medical Center Rural Health Clinic

  • Rural Health Clinic/Center
  • Warren, AR
National Provider Identifier
1174044697
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRADLEY COUNTY MEDICAL CENTER
Doing business as
Bradley County Medical Center Rural Health Clinic
Practice address
304 East Central
Warren, AR 71671-0000
Phone
(870) 226-8636
Fax
(870) 226-8655
NPI assigned
Jul 6, 2017
Last updated
Nov 11, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BRADLEY COUNTY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Authorized official

Name
Mrs. Leslie Huitt
Title
Ceo/Cfo
Phone
(870) 226-4301

Specialties & licenses 1

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

Addresses

Primary practice location

304 East Central
Warren, AR 71671-0000

Mailing address

404 S Bradley St
Warren, AR 71671-3459
Phone (870) 226-4301

Other names 1

  • Bradley County Medical Center Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040105000148 AR Part B Supplier - Clinic/Group Practice 2961316112 Receives reassigned benefits from 25 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warren, AR
O20170808000890 AR Part A Provider - Rural Health Clinic 2961316112 Practice locations: Warren, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174044697. Details of each certification follow.

Rural health clinic certification: CCN 048518

Legal name
BRADLEY COUNTY MEDICAL CENTER
Doing business as
BRADLEY COUNTY MEDICAL CENTER RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 13, 2018
Last certification
Jun 3, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1997 in AR
Enrollment address
304 East Central Street
Warren, AR 71671-3452
Related CCNs
041327

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Scott C Claycomb

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/bradley-49d5c27e

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Joe H Wharton Individual Corporate OfficerBoard Member Mar 27, 2008 12.5%
Corporate DirectorBoard Member Mar 27, 2008 12.5%
Bradley County Medical Center Organization, Warren, AR Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 1997 100%
Operational/Managerial Control Oct 1, 1997 100%
Freddie M Mobley Individual Corporate OfficerChairman Feb 24, 2000 12.5%
Corporate DirectorChairman Feb 24, 2000 12.5%
Joe Don Greenwood Individual Corporate OfficerVice Chairman Oct 20, 2003 12.5%
Corporate DirectorVice Chairman Oct 20, 2003 12.5%
Belinda Gail McGhee Individual Corporate OfficerBoard Member Mar 18, 2022
Earnest Callum Individual Corporate OfficerBoard Member Oct 22, 2015 12.5%
Corporate DirectorBoard Member Oct 22, 2015 12.5%
Leslie Huitt Individual Corporate DirectorCfo/Interim Ceo Dec 2, 2021 50%
W-2 Managing EmployeeCfo/Interim Ceo May 4, 2020 50%
Michael Milton Individual Corporate OfficerBoard Member Jul 1, 2023
French Wynne Individual Corporate OfficerBoard of Director Jan 16, 2023

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Bradley County Medical CenterWarren, AR, CCN 041327 Hospital Operational/Managerial Control (100%) Jun 10, 1997
Bradley County Medical CenterWarren, AR, CCN 04M327 Hospital Operational/Managerial Control (100%) Jan 1, 1966
Bradley County Medical CenterWarren, AR, CCN 04Z327 Hospital Operational/Managerial Control (100%) Oct 31, 2007
Bradley County Medical Center Home Health AgencyWarren, AR, CCN 047140 Home health agency Operational/Managerial Control (100%) Jan 20, 1993

Owned or controlled facilities with NPI records 4

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

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": "1499299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1174044697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 S BRADLEY ST",
            "city": "WARREN",
            "state": "AR",
            "postal_code": "716713459",
            "telephone_number": "870-226-4301",
            "fax_number": "870-226-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 EAST CENTRAL",
            "city": "WARREN",
            "state": "AR",
            "postal_code": "716710000",
            "telephone_number": "870-226-8636",
            "fax_number": "870-226-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY COUNTY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRADLEY COUNTY MEDICAL CENTER",
        "enumeration_date": "2017-07-06",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A",
        "authorized_official_last_name": "HUITT",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "CEO/CFO",
        "authorized_official_telephone_number": "870-226-4301",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bradley County Medical Center Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warren, AR

Sources for this page

Verify at the official NPI Registry.