Access Medical Clinic Arkansas LTC LLC
Organization Active NPI Rural Health Clinic/Center · Lonoke, AR
NPI 1265065064 · NPPES record last updated Jan 8, 2024
Key facts
- NPI
- 1265065064
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
- Practice address
- 1010 N Center St
Lonoke, AR 72086 - Phone
- (501) 438-8075
- Fax
- (870) 895-2164
- NPI assigned
- Feb 20, 2020
- Organization subpart
- No
Authorized official
- Name
- Monya York
- Title
- Controller
- Phone
- (870) 856-1202
Owners & managing parties with NPI records 4
-
Randi L Davis, APRN
-
Sheri N. Davis, A.P.R.N., FNP-C
-
Mark S Hahn, DO
Other NPIs on the same Medicare enrollment 44
Other NPIs with the same Medicare PAC ID 8
Member of 1
Facilities with the same owner 7
Practitioners 142
-
April Leann Davis, FNP-BC
-
Lacey Head Farrar, MSN, AG-ACNP, FNP
-
Pamela Hughey, APN
-
Dillon Clifford Louton, APRN
-
Rickey Edna Mack, CNP
-
Lindsay Marie Massey, CNP
-
Tracy C Poole, NP
-
Dedra Ann Richardson, APRN
-
Ebony Baker, NP
-
Jody A Barham, APN
-
Sara Bayird, APRN
-
Neeraj Bharany, M.D.
-
Shannon Black, FNP-BC
-
Colleen Marie Blanchard, APRN-CNP
-
Verona Tice Brown-Bebow, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2290495 | Access Medical Clinic Arkansas LTC LLC | Certificate of waiver | Sep 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in AR
Rural health clinic certification: CCN 043913
- Legal name
- ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 2, 2021
- Last certification
- Feb 2, 2021
- Ownership / control type
- 1C
- Most recent change of ownership
- Jan 1, 2024 (1 total)
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 24, 2023 in AR
- Enrollment address
- 1010 N Center St
Lonoke, AR 72086-2005
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Mark Hahn |
5% Or Greater Indirect Ownership Interest |
May 8, 2025 | |
| Jared Clifford |
Corporate Officer |
May 8, 2025 | |
| Access Medical Clinic Arkansas LLC |
5% Or Greater Direct Ownership Interest | Jul 24, 2023 | 100% |
| Sheri N Davis |
W-2 Managing Employee |
May 8, 2025 | |
| Monya York |
W-2 Managing Employee | Jul 24, 2023 | |
| Operational/Managerial Control | Jul 24, 2023 | ||
| Randi L Davis |
W-2 Managing Employee |
May 8, 2025 | |
| Candice M Cartwright |
W-2 Managing Employee |
May 8, 2025 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jan 1, 2024 | Change of Ownership |
Access Medical Clinic Arkansas LLC |
| Jan 1, 2024 | Change of Ownership |
Access Medical Clinic Arkansas LTC LLC |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170124001288 | AR | Part B Supplier - Clinic/Group Practice | 5890077093 |
Receives reassigned benefits from 171 practitioners 43 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Heber Springs, AR; Hope, AR; Lamar, AR; Mena, AR; Mountain Home, AR; Newport, AR; Osceola, AR; Ozark, AR… |
| O20231121000733 | AR | Part a Provider - Rural Health Clinic | 0547618175 | Practice locations: Lonoke, AR |
| O20231208000065 | AR | Part B Supplier - Clinic/Group Practice | 0547618175 |
Receives reassigned benefits from 126 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Malvern, AR; Weiner, AR; Perryville, AR; Marshall, AR; Lonoke, AR; Greenbrier, AR; Concord, AR; Cave City, AR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1010 N Center St
Lonoke, AR 72086
Mailing address
4196 Highway 62 412 Ste a
Hardy, AR 72542-8002
Other providers in Lonoke, AR
All providers in Lonoke, AR · Rural Health Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.