NPIMap

Organization Active NPI

Boston Mountain Rural Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Marshall, AR
National Provider Identifier
1225703259
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOSTON MOUNTAIN RURAL HEALTH CENTER INC
Practice address
106 Westwood Dr
Marshall, AR 72650-7861
Phone
(870) 448-3455
Fax
(870) 448-3392
NPI assigned
Aug 11, 2021
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
Debbie Ackerson
Title
Ceo
Phone
(870) 448-5733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

106 Westwood Dr
Marshall, AR 72650-7861

Mailing address

PO Box 1060
Marshall, AR 72650-1060
Phone (870) 448-5733

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040701000737 AR Part B Supplier - Clinic/Group Practice 3870401722 Receives reassigned benefits from 58 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jasper, AR; Lead Hill, AR; Marshall, AR; Mountain Home, AR; Mountain View, AR; Quitman, AR; Shirley, AR; Yellville, AR…
O20211015000647 AR Part A Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Marshall, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225703259. Details of each certification follow.

Federally qualified health center certification: CCN 041984

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 13, 2021
Last certification
Oct 13, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 1997 in AR
Enrollment address
106 Westwood Dr
Marshall, AR 72650-7861

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 13

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

View all 13

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
04D2229847Boston MTN Rural Health Center Inc -Marshall106 Westwood Dr, Marshall, AR 72650Certificate of waiverJul 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Boston Mountain Rural H25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Boston Mountain Rural Health Center, Inc Organization, Marshall, AR Non-profit Other Mar 14, 1994
Debbie Ackerson Individual Corporate OfficerCeo Dec 1, 2017
Christopher Graham Individual Corporate Director Jan 10, 2003
Donna Samples Individual Corporate DirectorBoard Member Jan 10, 2003
Rebecca Blair Individual Corporate DirectorCfo Dec 16, 2013
W-2 Managing EmployeeCfo Dec 16, 2013
Danny Horton Individual Corporate DirectorBoard Member Feb 1, 2015

Owners & managing parties with NPI records 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 5

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": "1628640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1225703259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1060",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "726501060",
            "telephone_number": "870-448-5733",
            "fax_number": "870-448-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 WESTWOOD DR",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "726507861",
            "telephone_number": "870-448-3455",
            "fax_number": "870-448-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MOUNTAIN RURAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-11",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "ACKERSON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-448-5733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, AR

Sources for this page

Verify at the official NPI Registry.