Baptist Health

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

BAPTIST HEALTH

Doing business as

Baptist Health Family Clinic - Sheridan

Practice address

21 Opportunity Dr
Sheridan, AR 72150-9185

Phone

(501) 337-9066

NPI assigned

Mar 15, 2024

Last updated

Mar 15, 2024By 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

Troy Wells

Title

President

Phone

(501) 202-2080

Specialties & licenses 1

Addresses

Other names 1

• Baptist Health Family Clinic - Sheridan Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255190989. Details of each certification follow.

• CCN 048545 Rural health clinic · Active · Details

Rural health clinic certification: CCN 048545

Legal name

BAPTIST HEALTH

Doing business as

BAPTIST HEALTH FAMILY CLINIC - SHERIDAN

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jul 29, 2024

Last certification

Jul 29, 2024

Ownership / control type

2B

Organization structure

CorporationNon-profit

Incorporated

Oct 1, 1920 in AR

Enrollment address

651 Heritage Dr
Sheridan, AR 72150-5000

Related CCNs

040076

Related certifications (CCN) 1

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

• Baptist Health

  dba Baptist Health Medical Center- Hot Spring County

  • General Acute Care Hospital
  • Malvern, AR
  • NPI 1902868391

  Parent provider

  Provider of Services

Other NPIs on the same Medicare enrollment 1

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

• Baptist Health

  dba Baptist Health Family Clinic - Sheridan

  • Rural Health Clinic/Center
  • Sheridan, AR
  • NPI 1114792157

  O20240506003733

  Same enrollment

All disclosed owners & managing parties 20

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

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

{
    "created_epoch": "1710460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1255190989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9601 BAPTIST HEALTH DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056321",
            "telephone_number": "501-202-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 OPPORTUNITY DR",
            "city": "SHERIDAN",
            "state": "AR",
            "postal_code": "721509185",
            "telephone_number": "501-337-9066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-15",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-202-2080"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Health Family Clinic - Sheridan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Arkansas Health Group (Baptist Health Family Clinic Sheridan)
• Assisted Care for Seniors
• David Bagley, MD
• Meredith Gayle Bailey, M.S., CCC-SLP
• Baptist Health (Baptist Health Family Clinic - Sheridan)
• Shagala Barnett
• Chrystal A Batemon, MHPP
• Nicole Danise Bates, APRN, FNP-BC
• Elizabeth Ann Baxley, SLP
• Randi Leann Beard

• Rural Health Clinic/Center in Sheridan, AR
• Providers in Sheridan, 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 Mar 15, 2024; 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.