NPIMap

Organization Active NPI

Holden Psychiatric Institute, PA

  • Psychiatry Physician
  • Bentonville, AR
National Provider Identifier
1205001088
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
HOLDEN PSYCHIATRIC INSTITUTE, PA
Practice address
2707 SE G St
Bentonville, AR 72712-3740
Phone
(147) 936-7255
Fax
(479) 367-2584
NPI assigned
Apr 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

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

Authorized official

Name
Randy H Jenkins
Title
Office Manager
Phone
(479) 367-2552

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2707 SE G St
Bentonville, AR 72712-3740

Mailing address

2707 SE G St
Bentonville, AR 72712-3740
Phone (479) 367-2552

Other identifiers 3

IdentifierTypeStateIssuer
1891880373MedicaidMO
118344001MedicaidAR
100080220AMedicaidOK

Other names 1

  • Holden Institute Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040622001640 AR Part B Supplier - Clinic/Group Practice 9234114349 Receives reassigned benefits from 7 practitioners
Practice locations: Bentonville, AR

National Provider Directory

National Provider Directory
Tax ID family
Holden Institute2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2707 SE G St
Bentonville, AR 72712
Phone (479) 367-2552

2200 SE J St
Ste 14
Bentonville, AR 72712
Phone (479) 254-9777

Practitioners & affiliated clinicians

Practitioners 8

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": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1205001088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 SE G ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123740",
            "telephone_number": "479-367-2552",
            "fax_number": "479-367-2584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 SE G ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123740",
            "telephone_number": "147-936-7255",
            "fax_number": "479-367-2584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLDEN PSYCHIATRIC INSTITUTE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "479-367-2552"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891880373",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118344001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100080220A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holden Institute",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Holden Institute",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.