NPIMap

Organization Active NPI

Access Medical Clinic Arkansas LTC LLC

  • Rural Health Clinic/Center
  • Lonoke, AR
National Provider Identifier
1265065064
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 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
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Monya York
Title
Controller
Phone
(870) 856-1202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

1010 N Center St
Lonoke, AR 72086

Mailing address

4196 Highway 62 412 Ste a
Hardy, AR 72542-8002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265065064. Details of each certification follow.

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
LLCProprietary
Incorporated
Jul 24, 2023 in AR
Enrollment address
1010 N Center St
Lonoke, AR 72086-2005

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 44

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

View all 44

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
04D2290495Access Medical Clinic Arkansas LTC LLC1010 N Center St, Lonoke, AR 72086Certificate of waiverSep 25, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4196 Highway 62 412
#A
Hardy, AR 72542
Phone (870) 856-2100

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Mark Hahn Individual 5% Or Greater Indirect Ownership InterestMedical Director May 8, 2025
Jared Clifford Individual Corporate OfficerPresident May 8, 2025
Access Medical Clinic Arkansas LLC Organization, Hardy, AR LLC 5% Or Greater Direct Ownership Interest Jul 24, 2023 100%
Sheri N Davis Individual W-2 Managing EmployeeVP of Provider Mgmnt May 8, 2025
Monya York Individual W-2 Managing Employee Jul 24, 2023
Operational/Managerial Control Jul 24, 2023
Randi L Davis Individual W-2 Managing EmployeeDirector Provider Mgmnt May 8, 2025
Candice M Cartwright Individual W-2 Managing EmployeeClinic Director May 8, 2025

Owners & managing parties with NPI records 4

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

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 2

DateEventCounterparty
Jan 1, 2024 Change of OwnershipThis provider was the buyer Access Medical Clinic Arkansas LLCCCN 043913, AR, NPI 1265065064
Jan 1, 2024 Change of OwnershipThis provider was the seller Access Medical Clinic Arkansas LTC LLCCCN 043913, AR, NPI 1265065064

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1582156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1265065064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002",
            "fax_number": "870-856-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 N CENTER ST",
            "city": "LONOKE",
            "state": "AR",
            "postal_code": "72086",
            "telephone_number": "501-438-8075",
            "fax_number": "870-895-2164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS MEDICAL CLINIC ARKANSAS LTC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-20",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "MONYA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "870-856-1202"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lonoke, AR

Sources for this page

Verify at the official NPI Registry.