NPIMap

Organization Active NPI

Johnson Regional Medical Center

  • Obstetrics & Gynecology Physician
  • Clarksville, AR
National Provider Identifier
1174583603
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
JOHNSON REGIONAL MEDICAL CENTER
Doing business as
Clarksville Women's Center
Practice address
1100 E Poplar St
Clarksville, AR 72830-4419
Phone
(479) 754-5337
Fax
(479) 754-5348
NPI assigned
Mar 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Larry Morse
Title
Administrator
Phone
(479) 754-2060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1100 E Poplar St
Clarksville, AR 72830-4419

Mailing address

PO Box 1836
Clarksville, AR 72830-1836
Phone (479) 754-5337

Other identifiers 1

IdentifierTypeStateIssuer
5F191OtherARARK BLUE CROSS

Other names 1

  • Clarksville Women's Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050307000130 AR Part B Supplier - Clinic/Group Practice 1658360284 Receives reassigned benefits from 3 practitioners
Practice locations: Clarksville, AR

Other NPIs with the same Medicare PAC ID 9

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
04D2063541Clarksville Women'S Center1100 E Poplar, Suite a, Clarksville, AR 72830Provider-performed microscopyAug 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Johnson Regional Med Ctr10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Johnson Regional Medical CenterClarksville, AR, CCN 040002 Hospital Operational/Managerial Control Jan 4, 2012
JRMC Senior Care UnitClarksville, AR, CCN 04S002 Hospital 5% Or Greater Direct Ownership Interest Jun 4, 2002

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174583603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1836",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728301836",
            "telephone_number": "479-754-5337",
            "fax_number": "479-754-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E POPLAR ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304419",
            "telephone_number": "479-754-5337",
            "fax_number": "479-754-5348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MORSE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "479-754-2060",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARK BLUE CROSS",
            "identifier": "5F191",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarksville Women's Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, AR

Sources for this page

Verify at the official NPI Registry.