NPIMap

Jefferson Hospital Association, Inc

Organization Active NPI Cardiovascular Disease Physician · Pine Bluff, AR

NPI 1174542906 · NPPES record last updated Mar 18, 2020

Key facts

NPI
1174542906
Entity type
Organization (NPI type 2)
Primary specialty
Cardiovascular Disease Physician 207RC0000X
License
E-4501 (AR)
Legal business name
JEFFERSON HOSPITAL ASSOCIATION, INC
Practice address
1601 W 40TH
Suite 301
Pine Bluff, AR 71603
Phone
(870) 541-7220
NPI assigned
Jul 19, 2006
Organization subpart
No

Authorized official

Name
Mr. Walter Johnson
Title
Ceo
Phone
(870) 541-7269

Owned or controlled facilities with NPI records 5

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

Other NPIs with the same Medicare PAC ID 8

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

Corporate family (same tax ID) 14

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

Practitioners 80

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 80

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AR

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Jefferson Regional Specialty Hospital
White Hall, AR · CCN 043038		 Hospital 5% Or Greater Direct Ownership Interest (60%) Jun 4, 2024
Jefferson Regional Specialty Hospital
White Hall, AR · CCN 04SD38		 Hospital 5% Or Greater Direct Ownership Interest (60%) Jun 4, 2024
Jefferson Homecare
White Hall, AR · CCN 047093		 Home health agency 5% Or Greater Direct Ownership Interest (33%) Jun 1, 2008
Jefferson Regional Monticello Medical Clinic
Monticello, AR · CCN 048533		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 1966
Jefferson Regional Crossett Clinic
Crossett, AR · CCN 048532		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 1966

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070202000152 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 4 practitioners
Practice locations: Crossett, AR; Dumas, AR; Monticello, AR; Pine Bluff, AR

National Provider Directory

Tax ID family
Jefferson Regional Med (15 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207RC0000X E-4501 AR Yes

Addresses

Primary practice location

1601 W 40TH
Suite 301
Pine Bluff, AR 71603

Mailing address

1601 W 40TH
Suite 301
Pine Bluff, AR 71603
Phone (870) 541-4285

Other identifiers

IdentifierTypeStateIssuer
5F630OtherARBCBS
DF4052OtherARRAILROAD MEDICARE
163127002MedicaidAR

Other names

  • Cardiology Associates Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 18, 2020.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584489600000",
    "number": "1174542906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 W 40TH",
            "address_2": "SUITE 301",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71603",
            "telephone_number": "870-541-4285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 W 40TH",
            "address_2": "SUITE 301",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71603",
            "telephone_number": "870-541-7220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-541-7269",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AR",
            "license": "E-4501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5F630",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF4052",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163127002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardiology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cardiology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Bluff, AR

All providers in Pine Bluff, AR · Cardiovascular Disease Physician in Arkansas

Sources for this page

Verify at the official NPI Registry.