NPIMap

Organization Active NPI

Baxter County Regional Hospital, Inc

Doing business as Baxter Health Med-Peds Clinic

  • Pediatrics Physician
  • Mountain Home, AR
National Provider Identifier
1174131502
Registry record updated Jul 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
BAXTER COUNTY REGIONAL HOSPITAL, INC
Doing business as
Baxter Health Med-Peds Clinic
Practice address
10 Medical PLZ
Mountain Home, AR 72653-2918
Phone
(870) 424-3824
Fax
(870) 424-3826
NPI assigned
Jul 22, 2020
Last updated
Jul 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2023

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

10 Medical PLZ
Mountain Home, AR 72653-2918

Mailing address

10 Medical PLZ
Mountain Home, AR 72653-2918
Phone (870) 424-3824

Other names 1

  • Baxter Health Med-Peds Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080514000435 AR Part B Supplier - Clinic/Group Practice 0042389264 Receives reassigned benefits from 16 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mountain Home, AR; Harrison, AR

Other NPIs on the same Medicare enrollment 6

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

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
04D2189382Baxter Health Med-Peds Clinic10 Medical Plaza, Mountain Home, AR 72653Certificate of waiverJul 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Baxter Cty Reg Hosp16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

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.

NPI Registry JSON

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689724800000",
    "number": "1174131502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MEDICAL PLZ",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532918",
            "telephone_number": "870-424-3824",
            "fax_number": "870-424-3826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MEDICAL PLZ",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532918",
            "telephone_number": "870-424-3824",
            "fax_number": "870-424-3826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAXTER COUNTY REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-22",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "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": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baxter Health Med-Peds Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.