NPIMap

Organization Active NPI

Rural Health Pain Management LLC

  • Pain Medicine (Anesthesiology) Physician
  • Forrest City, AR
National Provider Identifier
1265039556
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
RURAL HEALTH PAIN MANAGEMENT LLC
Practice address
1601 New Castle Rd
Forrest City, AR 72335-2218
Phone
(870) 261-0000
NPI assigned
Oct 8, 2020
Last updated
Apr 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

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

Authorized official

Name
Jeremy Daves, CRNANPI 1063513612
Title
Owner
Phone
(817) 239-2964

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary

Addresses

Primary practice location

1601 New Castle Rd
Forrest City, AR 72335-2218

Mailing address

(Admin) 5545 Murray Ave
Suite 130
Memphis, TN 38119
Phone (901) 682-6828

Other practice location 1

900 W Kingshighway
Paragould, AR 72450-5942
Phone (870) 239-7000

Other practice location 2

2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396
Phone (573) 776-2000

Other practice location 3

420 Wilkinson Dr
Dyersburg, TN 38024-2085
Phone (901) 682-6828

Other practice location 4

112 E Commercial Ave
Anaconda, MT 59711-2245
Phone (406) 200-9233

Other practice location 5

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone (573) 776-2000

Other practice location 6

301 Tyson Ave
Paris, TN 38242-4544
Phone (817) 239-2964

Other practice location 7

161 Mount Pelia Rd
Martin, TN 38237-3811
Phone (901) 682-6828

Other practice location 8

209 NW 8th St Ste J
Seminole, TX 79360-3447
Phone (901) 682-6828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MO, AR, MT4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20201209000323 TN Part B Supplier - Clinic/Group Practice 8921410341 Receives reassigned benefits from 5 practitioners
Practice locations: Dyersburg, TN; Martin, TN; Milan, TN; Paris, TN
O20210512002296 MO Part B Supplier - Clinic/Group Practice 8921410341 Receives reassigned benefits from 25 practitioners
Practice locations: Poplar Bluff, MO
O20220121002281 AR Part B Supplier - Clinic/Group Practice 8921410341 Receives reassigned benefits from 37 practitioners
Practice locations: Clarksville, AR; Blytheville, AR; Paragould, AR; Forrest City, AR; Helena, AR
O20241203003878 MT Part B Supplier - Clinic/Group Practice 8921410341 Receives reassigned benefits from 6 practitioners
Practice locations: Anaconda, MT

National Provider Directory

National Provider Directory

Locations

112 E Commercial Ave
Anaconda, MT 59711
Phone (406) 490-0124

209 NW 8th St
Ste J
Seminole, TX 79360

Practitioners & affiliated clinicians

Practitioners 81

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 81

NPI Registry JSON

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

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743552000000",
    "number": "1265039556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "(ADMIN) 5545 MURRAY AVE",
            "address_2": "SUITE 130",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38119",
            "telephone_number": "901-682-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 NEW CASTLE RD",
            "city": "FORREST CITY",
            "state": "AR",
            "postal_code": "723352218",
            "telephone_number": "870-261-0000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 W Kingshighway",
            "address_purpose": "LOCATION",
            "city": "Paragould",
            "state": "AR",
            "postal_code": "724505942",
            "country_code": "US",
            "telephone_number": "870-239-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2620 N Westwood Blvd",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639013396",
            "country_code": "US",
            "telephone_number": "573-776-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "420 Wilkinson Dr",
            "address_purpose": "LOCATION",
            "city": "Dyersburg",
            "state": "TN",
            "postal_code": "380242085",
            "country_code": "US",
            "telephone_number": "901-682-6828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "112 E Commercial Ave",
            "address_purpose": "LOCATION",
            "city": "Anaconda",
            "state": "MT",
            "postal_code": "597112245",
            "country_code": "US",
            "telephone_number": "406-200-9233",
            "fax_number": "406-213-8550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3100 Oak Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639011573",
            "country_code": "US",
            "telephone_number": "573-776-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 Tyson Ave",
            "address_purpose": "LOCATION",
            "city": "Paris",
            "state": "TN",
            "postal_code": "382424544",
            "country_code": "US",
            "telephone_number": "817-239-2964",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "161 Mount Pelia Rd",
            "address_purpose": "LOCATION",
            "city": "Martin",
            "state": "TN",
            "postal_code": "382373811",
            "country_code": "US",
            "telephone_number": "901-682-6828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "209 NW 8th St Ste J",
            "address_purpose": "LOCATION",
            "city": "Seminole",
            "state": "TX",
            "postal_code": "793603447",
            "country_code": "US",
            "telephone_number": "901-682-6828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RURAL HEALTH PAIN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-08",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "DAVES",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-239-2964",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forrest City, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.