NPIMap

Organization Active NPI

White River Health System, Inc.

Doing business as White River Health Neurology

  • Neurology Physician
  • Batesville, AR
National Provider Identifier
1235101601
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
WHITE RIVER HEALTH SYSTEM, INC.
Doing business as
White River Health Neurology
Practice address
1699 Harrison St
Suite D
Batesville, AR 72501-7302
Phone
(870) 793-5200
Fax
(870) 793-5277
NPI assigned
Feb 1, 2006
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Shawna Baxter
Title
Provider Enrollment
Phone
(870) 262-5545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

1699 Harrison St
Suite D
Batesville, AR 72501-7302

Mailing address

1699 Harrison St Ste D
Batesville, AR 72501-7318
Phone (870) 262-5545

Other identifiers 1

IdentifierTypeStateIssuer
152070002MedicaidAR

Other names 1

  • WHITE RIVER HEALTH NEUROLOGY Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031204000986 AR Part B Supplier - Clinic/Group Practice 0143134270 Receives reassigned benefits from 18 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Heber Springs, AR; Newport, AR; Mountain View, AR; Cherokee Village, AR; Batesville, AR; Melbourne, AR
O20040216000496 AR Part A Provider - Hospital 0143134270 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Batesville, AR; Mountain View, AR; Cherokee Village, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235101601. Details of each certification follow.

Hospital certification: CCN 040119

Legal name
WHITE RIVER HEALTH SYSTEM, INC.
Doing business as
WHITE RIVER MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jan 30, 1976
Last certification
Apr 6, 2023
Beds
224
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 31, 1976 in AR
Enrollment address
1710 Harrison St
White River Medical Center
Batesville, AR 72501-7303
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

View all 13

Other NPIs on the same Medicare enrollment 16

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

View all 16

Care Compare: Hospital

Medicare Care Compare
Listed as
White River Medical CenterCCN 040119 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1699 Harrison St
Ste D
Batesville, AR 72501
Phone (870) 262-6282

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Crystal Johnson Individual Corporate DirectorBoard Member Jan 1, 2025
White River Health System, Inc. Organization, Batesville, AR Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 31, 1976
Operational/Managerial Control Jan 31, 1976
Steve Case Individual Corporate DirectorBoard Member Jan 1, 2025
Stacy Gunderman Individual Corporate DirectorBoard Member Jan 1, 2025
Maggie Williams Individual Corporate DirectorExecutive Director Jan 1, 2025
Danny Bell Individual Corporate DirectorBoard Member Jan 1, 2025
Robert McIntire Individual Corporate DirectorTreasurer Jan 1, 2025
Elizabeth Christian Individual Corporate DirectorBoard Member Jan 1, 2025
Jason Taylor Individual Corporate DirectorBoard Member Jan 1, 2025
Tina Wheelis Individual Corporate DirectorBoard Member Jan 1, 2025
Jeff Showalter Individual Corporate DirectorSecretary Jan 1, 2025
Shawna Baxter Individual W-2 Managing EmployeeProvider Enrollment Specialist Aug 28, 2023
Kevin S Rose Individual Corporate DirectorBoard Member Jan 1, 2025
Randy Cross Individual Corporate DirectorChair Jan 1, 2025
Kathy Lanier Individual Corporate DirectorBoard Member Jan 1, 2025
Lisa Lambert Individual Corporate DirectorExecutive Director Jan 1, 2024
William Tyler Fowlkes Individual Corporate DirectorVice Chair Jan 1, 2025
Lance Lamberth Individual Corporate DirectorBoard Member Jan 1, 2025

Practitioners & affiliated clinicians

Practitioners 26

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 26

Affiliated clinicians 353

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 353

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1235101601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1699 HARRISON ST STE D",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725017318",
            "telephone_number": "870-262-5545",
            "fax_number": "870-262-3253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1699 HARRISON ST",
            "address_2": "SUITE D",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725017302",
            "telephone_number": "870-793-5200",
            "fax_number": "870-793-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE RIVER HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "870-262-5545"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152070002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WHITE RIVER HEALTH NEUROLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Batesville, AR

Sources for this page

Verify at the official NPI Registry.