NPIMap

Organization Active NPI

Appello Health and Wellness Clinic, LLC

  • Rural Health Clinic/Center
  • Malvern, AR
National Provider Identifier
1215773262
Registry record updated Jul 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
APPELLO HEALTH AND WELLNESS CLINIC, LLC
Practice address
2223 Grant St
Malvern, AR 72104-4700
Phone
(501) 337-9031
NPI assigned
Jul 8, 2024
Last updated
Jul 31, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2026

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

Authorized official

Name
Jason Wayne Lee
Title
Manager
Phone
(501) 772-7518

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2223 Grant St
Malvern, AR 72104-4700

Mailing address

500 President Clinton Ave Ste 200-F
Little Rock, AR 72201-1756
Phone (501) 337-9031

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240912002189 AR Part A Provider - Rural Health Clinic 3971043290 Practice locations: Malvern, AR
O20250307001951 AR Part B Supplier - Clinic/Group Practice 3971043290 Receives reassigned benefits from 80 practitioners
Practice locations: Malvern, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215773262. Details of each certification follow.

Rural health clinic certification: CCN 043956

Legal name
APPELLO HEALTH AND WELLNESS CLINIC LLC
Doing business as
PG ANCILLARIES LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 11, 2025
Last certification
Feb 11, 2025
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Dec 18, 2023 in AR
Enrollment address
2223 Grant St
Malvern, AR 72104-4700

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
04D2314349Appello Health and Wellness Medical Clinic2223 Grant St, Malvern, AR 72104Certificate of waiverNov 18, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
David L Norsworthy Individual 5% Or Greater Indirect Ownership InterestChief Operating Officer Jul 11, 2024 15.37%
Corporate DirectorChief Operating Officer (Coo) Jul 11, 2024 20%
Jej Assets LP Organization, Shreveport, LA Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 11, 2024 25%
Bryan Milburn Adams Individual 5% Or Greater Indirect Ownership Interest Jul 11, 2024 5%
Arkansas Superior Select Inc Organization, Little Rock, AR Corporation, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 11, 2024 100%
Select Founders LLC Organization, Little Rock, AR Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 11, 2024 100%
PG Assets LLC Organization, Shreveport, LA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 11, 2024 25%
William Mainord Individual 5% Or Greater Indirect Ownership InterestDirector Jul 11, 2024 5%
Corporate Director Jul 11, 2024 20%
John F Ponthie Individual 5% Or Greater Indirect Ownership Interest Jul 11, 2024 12.5%
Corporate DirectorDirector Jul 11, 2024 20%
Sharlot Ponthie Individual 5% Or Greater Indirect Ownership Interest Jul 11, 2024 12.5%
Michael S Morton Individual 5% Or Greater Indirect Ownership InterestCeo Jul 11, 2024 39.63%
Corporate DirectorCeo Jul 11, 2024 20%
Dalana Huckaby Individual W-2 Managing EmployeeClinic Manager Jul 11, 2024 100%
Tobey Koehler Individual 5% Or Greater Indirect Ownership Interest Jul 11, 2024 5%
4P2T1 Ops Holding LP Organization, Shreveport, LA Holding company 5% Or Greater Indirect Ownership Interest Jul 11, 2024 25%
Anthony Brandon Adams Individual 5% Or Greater Indirect Ownership Interest Jul 11, 2024 5%
Select Investments, LLC Organization, Conway, AR LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 11, 2024 20%

Facilities with the same owner 38

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

View all 38

Practitioners & affiliated clinicians

Practitioners 88

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.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785456000000",
    "number": "1215773262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PRESIDENT CLINTON AVE STE 200-F",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722011756",
            "telephone_number": "501-337-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 GRANT ST",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721044700",
            "telephone_number": "501-337-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPELLO HEALTH AND WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-08",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "501-772-7518"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malvern, AR

Sources for this page

Verify at the official NPI Registry.