NPIMap

Organization Active NPI

Mountain Home Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Mountain Home, AR
National Provider Identifier
1205978780
Registry record updated Feb 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
2345 Issued in AR
Legal business name
MOUNTAIN HOME SURGERY CENTER
Practice address
360 Highway 5 N
Mountain Home, AR 72653-3039
Phone
(870) 425-2277
Fax
(870) 425-2021
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2014

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

Authorized official

Name
Dr. Kenneth Allan Jones, M.D.
Title
President
Phone
(870) 425-2277

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 2345 AR Primary

Addresses

Primary practice location

360 Highway 5 N
Mountain Home, AR 72653-3039

Mailing address

360 Highway 5 N
Mountain Home, AR 72653-3039
Phone (870) 425-2277

Other identifiers 3

IdentifierTypeStateIssuer
2345OtherARSTATE LICENSE NUMBER
194829128MedicaidAR
118386128MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140208000073 AR Part B Supplier - Ambulatory Surgical Center 0345479655 Receives reassigned benefits from 2 practitioners
Practice locations: Mountain Home, AR

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Mountain Home Surgery CenterCCN 04C0001017
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Mountain Home Surgery Center2 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.

Practitioners & affiliated clinicians

Practitioners 6

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391817600000",
    "number": "1205978780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 HIGHWAY 5 N",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726533039",
            "telephone_number": "870-425-2277",
            "fax_number": "870-425-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 HIGHWAY 5 N",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726533039",
            "telephone_number": "870-425-2277",
            "fax_number": "870-425-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN HOME SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2014-02-08",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-425-2277",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AR",
            "license": "2345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "2345",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194829128",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118386128",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.