St. Anthony's Hospital Association

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ST. ANTHONY'S HOSPITAL ASSOCIATION

Doing business as

CHI St. Vincent Primary Care-Morrilton

Practice address

1711 E Harding St
Morrilton, AR 72110-4507

Phone

(501) 354-4637

Fax

(501) 552-5326

NPI assigned

Jan 6, 2006

Last updated

Sep 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tiffany R Hogan

Title

Practice Manager

Phone

(501) 354-4637

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• CHI St. Vincent Primary Care-Morrilton Doing business as

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215915459. Details of each certification follow.

• CCN 043477 Rural health clinic · Active · Details

Rural health clinic certification: CCN 043477

Legal name

ST ANTHONYS HOSPITAL ASSOCIATION

Doing business as

CHI ST. VINCENT MORRILTON

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jun 24, 1998

Last certification

Jun 28, 2018

Ownership / control type

2B

Organization structure

CorporationNon-profit

Incorporated

Jun 3, 1966 in AR

Enrollment address

1711 E Harding St
Morrilton, AR 72110-4510

Related CCNs

041324

Related certifications (CCN) 1

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

• St Anthony's Hospital Association

  dba CHI St. Vincent Morrilton

  • Critical Access Hospital
  • Morrilton, AR
  • NPI 1891778049

  Parent provider

  Provider of Services

Other NPIs on the same Medicare enrollment 3

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

• St Anthony's Hospital Association

  dba CHI St. Vincent Morrilton

  • Critical Access Hospital
  • Morrilton, AR
  • NPI 1891778049

  O20071011000551

  Same enrollment
• St. Anthony's Hospital Association

  dba Morrilton Hospitalists Group

  • Hospitalist Physician
  • Morrilton, AR
  • NPI 1992137236

  O20080125000635

  Same enrollment
• St. Anthonys Hospital Association

  • Emergency Medicine Physician
  • Morrilton, AR
  • NPI 1174916258

  O20080125000635

  Same enrollment

All disclosed owners & managing parties 21

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

Owners & managing parties with NPI records 4

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

• Clayton D Borg, MD

  • Cardiovascular Disease Physician
  • Little Rock, AR
  • NPI 1427060581

  Corporate Director

  CMS ownership
• Matthew Lewis Law

  • Hospitalist Physician
  • Little Rock, AR
  • NPI 1598022535

  Corporate Director

  CMS ownership
• Neesa J McCollum Flaxman, M.D.

  • Anesthesiology Physician
  • Little Rock, AR
  • NPI 1073509956

  Corporate Director

  CMS ownership
• Frederick A. Meadors, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Little Rock, AR
  • NPI 1699851436

  Corporate Director

  CMS ownership

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.

• Robert Warren Balentine Jr., M.D.

  • Family Medicine Physician
  • Conway, AR
  • NPI 1609927706
  NPD
• Sara Elizabeth Damron, DNP

  • Acute Care Nurse Practitioner
  • Little Rock, AR
  • NPI 1104340645
  NPD
• Keith M Lipsmeyer, M.D.

  • Family Medicine Physician
  • Morrilton, AR
  • NPI 1528055738
  NPD
• Susan Hooten, APRN

  • Gerontology Nurse Practitioner
  • Morrilton, AR
  • NPI 1629422266
  NPD (past)

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1215915459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 E HARDING ST",
            "city": "MORRILTON",
            "state": "AR",
            "postal_code": "721104507",
            "telephone_number": "501-354-4637",
            "fax_number": "501-552-5326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 E HARDING ST",
            "city": "MORRILTON",
            "state": "AR",
            "postal_code": "721104507",
            "telephone_number": "501-354-4637",
            "fax_number": "501-552-5326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ANTHONY'S HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "HOGAN",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "501-354-4637"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C5434",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AR",
            "license": "N5860",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AR",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A01404",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134783729",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI St. Vincent Primary Care-Morrilton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St. Anthony's Hospital Assoc. (St. Anthony's Hospice)
• St. Anthony's Hospital Association (St. Vincent Morrilton)
• St. Anthony's Hospital Association (St. Anthony's Medical Center)
• St. Anthony's Hospital Association (St. Vincent Morrilton)
• St. Anthony's Hospital Association (St. Vincent Morrilton)
• St. Anthony's Hospital Association (St. Anthony's Medical Center)
• St. Anthony's Hospital Association (St. Vincent Morrilton)
• St. Anthony's Hospital Association (St. Vincent Morrilton)
• St. Anthony's Hospital Association (St. Vincent Morrilton)
• St. Anthony's Hospital Association (Morrilton Hospitalists Group)

• Rural Health Clinic/Center in Morrilton, AR
• Providers in Morrilton, AR by specialty
• Rural Health Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.