NPIMap

Organization Active NPI

Jefferson Comprehensive Care System, Inc

Doing business as Little Rock Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Little Rock, AR
National Provider Identifier
1194922849
Registry record updated Oct 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Doing business as
Little Rock Community Health Center
Practice address
1100 N University Ave
Suite 125
Little Rock, AR 72207-6343
Phone
(501) 663-0055
NPI assigned
Jun 27, 2007
Last updated
Oct 3, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
JEFFERSON COMPREHENSIVE CARE SYSTEM, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2013

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

Authorized official

Name
Ms. Chanda Evans-McField
Title
Cfo
Phone
(870) 536-5525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1100 N University Ave
Suite 125
Little Rock, AR 72207-6343

Mailing address

PO Box 1285
Pine Bluff, AR 71613-1285
Phone (870) 543-2380

Other identifiers 1

IdentifierTypeStateIssuer
150090749MedicaidAR

Other names 1

  • Little Rock Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030304000006 AR Part A Provider - Federally Qualified Health Center (FQHC) 5193634509 Practice locations: Little Rock, AR
O20040603001458 AR Part B Supplier - Clinic/Group Practice 5193634509 Receives reassigned benefits from 22 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Altheimer, AR; Redfield, AR; Pine Bluff, AR; North Little Rock, AR; Little Rock, AR; College Station, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194922849. Details of each certification follow.

Federally qualified health center certification: CCN 041851

Legal name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 23, 2003
Last certification
May 23, 2003
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Nov 30, 1972 in AR
Enrollment address
1100 N University Ave
Ste 125
Little Rock, AR 72207-6356
Related CCNs
041821

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Pine Bluff Health Clinic12 organizations share this tax ID, including this one
Part of
Pine Bluff Health Clinic

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Monica Williams Individual Corporate Director Mar 1, 2017
Lillie Reeves Individual Corporate Director Feb 16, 2014
Eduardo R. Ochoa Individual Corporate Director Feb 16, 2010
Belinda Jones Individual Corporate Director Feb 16, 2010
Bonita Corbin Individual Corporate Director Feb 16, 2010
Ivan Hudson Individual Corporate Director Mar 1, 2014
Cheryl Broughton Individual Corporate Director Mar 1, 2015
Edward Davis Individual Corporate Director Mar 1, 2018
Chanda Evans-McField Individual Corporate OfficerCfo Nov 24, 2010
W-2 Managing Employee Nov 24, 2010
Albert Lowery Individual Corporate Director Feb 16, 2010
Sandra J Brown Individual Corporate OfficerCeo Sep 18, 2012
Clarette Burns Individual Corporate Director Mar 1, 2018
Zackery Tallaferro Individual Corporate Director Mar 1, 2015
Patricia a Washington Individual Corporate Director May 13, 2013
William Burney Individual Corporate Director Mar 1, 2017
Jerry Malone Individual Corporate Director Mar 1, 2018
Linzie Anderson Individual Corporate Director Mar 1, 2019
Marie Lindquist Individual Corporate Director Mar 1, 2017
Dorcas Vangilst Individual Corporate Director Mar 1, 2019
Earnestine Daniels Individual Corporate Director Mar 1, 2015

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Downtown Little Rock Community Health CenterLittle Rock, AR, CCN 041055 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 30, 1972
Jefferson Comprehensive Care System, IncLittle Rock, AR, CCN 041051 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 30, 1972

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, 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": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380758400000",
    "number": "1194922849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1285",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716131285",
            "telephone_number": "870-543-2380",
            "fax_number": "870-535-4716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N UNIVERSITY AVE",
            "address_2": "SUITE 125",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722076343",
            "telephone_number": "501-663-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COMPREHENSIVE CARE SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFERSON COMPREHENSIVE CARE SYSTEM, INC",
        "enumeration_date": "2007-06-27",
        "last_updated": "2013-10-03",
        "status": "A",
        "authorized_official_last_name": "EVANS-MCFIELD",
        "authorized_official_first_name": "CHANDA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-536-5525",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150090749",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little Rock Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.