NPIMap

Organization Active NPI

Dardanelle Regional, LLC

Doing business as Dardanelle Regional Medical Center

  • Psychiatric Hospital Unit
  • Dardanelle, AR
National Provider Identifier
1205940236
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
DARDANELLE REGIONAL, LLC
Doing business as
Dardanelle Regional Medical Center
Practice address
200 North 3Rd Street
Dardanelle, AR 72834
Phone
(479) 229-4677
Fax
(479) 229-6162
NPI assigned
Aug 18, 2006
Last updated
Aug 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Authorized official

Name
Brandy Talley
Title
Controller
Phone
(479) 229-4677

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

200 North 3Rd Street
Dardanelle, AR 72834

Mailing address

200 North 3Rd Street
Dardanelle, AR 72834
Phone (479) 229-4677

Other names 1

  • Dardanelle Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220525002921 AR Part A Provider - Critical Access Hospital 0345576500 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Dardanelle, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205940236. Details of each certification follow.

Hospital certification: CCN 04M302

Legal name
DARDANELLE REGIONAL LLC
Doing business as
DARDANELLE REGIONAL MEDICAL CENTER
Organization structure
LLCNon-profit
Incorporated
Apr 25, 2019 in AR
Enrollment address
200 N 3Rd Street
Dardanelle, AR 72834-3802
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Dardanelle Regional LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Dardanelle Regional LLC Organization, Dardanelle, AR LLC 5% Or Greater Direct Ownership Interest Jan 1, 2022 100%
Conway Regional Medical Center Inc Organization, Conway, AR Corporation 5% Or Greater Indirect Ownership Interest Jan 1, 2022 100%
Alan Finley Individual Corporate DirectorBoard Member Jan 1, 2022 100%
W-2 Managing EmployeeCeo Jan 1, 2022 100%
Operational/Managerial ControlChief Executive Officer Jun 1, 2019 100%

Owners & managing parties with NPI records 3

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
Dardanelle Regional Medical CenterDardanelle, AR, CCN 04Z302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022
Dardanelle Regional Medical CenterDardanelle, AR, CCN 041302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 12

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": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1205940236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NORTH 3RD STREET",
            "city": "DARDANELLE",
            "state": "AR",
            "postal_code": "72834",
            "telephone_number": "479-229-4677",
            "fax_number": "479-229-6162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NORTH 3RD STREET",
            "city": "DARDANELLE",
            "state": "AR",
            "postal_code": "72834",
            "telephone_number": "479-229-4677",
            "fax_number": "479-229-6162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DARDANELLE REGIONAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "479-229-4677"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dardanelle Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dardanelle, AR

Sources for this page

Verify at the official NPI Registry.