NPIMap

Organization Active NPI

Access Medical Clinic Arkansas LLC

  • Rural Health Clinic/Center
  • Clarksville, AR
National Provider Identifier
1265127591
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACCESS MEDICAL CLINIC ARKANSAS LLC
Practice address
409 S Rogers St
Clarksville, AR 72830-3743
Phone
(479) 746-7090
Fax
(479) 476-7091
NPI assigned
Apr 11, 2023
Last updated
Jul 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 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 NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

409 S Rogers St
Clarksville, AR 72830-3743

Mailing address

4196 Highway 62 412 Ste a
Hardy, AR 72542-8002
Phone (870) 856-1202

Medicare participation

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

Enrollment records 2

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…
O20231030001775 AR Part A Provider - Rural Health Clinic 5890077093 Practice locations: Clarksville, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265127591. Details of each certification follow.

Rural health clinic certification: CCN 043943

Legal name
ACCESS MEDICAL CLINIC ARKANSAS LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 18, 2024
Last certification
Jul 18, 2024
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Dec 2, 2016 in AR
Enrollment address
409 S Rogers St
Clarksville, AR 72830-3743

Other NPIs on the same Medicare enrollment 43

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

View all 43

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
04D2281762Access Medical Clinic Arkansas, LLC409 Rogers St, Clarksville, AR 72830Certificate of waiverMay 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Access Medical Clinic Arkansas LLC20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

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
Howard Freeman Individual Corporate DirectorSVP of Clinic Division May 14, 2026
W-2 Managing EmployeeAd; May 14, 2026
Operational/Managerial ControlSVP of Clinic Division May 14, 2026
Mark Hahn Individual 5% Or Greater Direct Ownership Interest May 8, 2025
Corporate OfficerMedical Director May 8, 2025
Tony D James Individual Corporate OfficerCfo May 14, 2026
W-2 Managing EmployeeAd; May 14, 2026
Jared Clifford Individual Corporate OfficerCeo May 15, 2026
W-2 Managing EmployeeAd; May 8, 2025
Monya York Individual Corporate DirectorCredentialing Director Jul 1, 2017
W-2 Managing Employee May 8, 2025
Randi L Davis Individual Corporate DirectorSr Director Clinic Operations May 14, 2026
W-2 Managing EmployeeAd; May 8, 2025
Operational/Managerial ControlSr Director Clinic Operations May 14, 2026
Kasey Crawford Individual Corporate DirectorDirector Clinic Operation May 14, 2026
W-2 Managing EmployeeAd; May 14, 2026
Operational/Managerial ControlDirector Clinic Operation May 14, 2026

Owners & managing parties with NPI records 2

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

  • Randi L Davis, APRN
    • Family Nurse Practitioner
    • Bay, AR
    • NPI 1740622497

    Corporate Director, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership
  • Mark S Hahn, DO
    • Family Medicine Physician
    • Caraway, AR
    • NPI 1609895911

    5% Or Greater Direct Ownership Interest, Corporate Officer

    CMS ownership

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Access Medical Clinic Arkansas LTC LLCLonoke, AR, CCN 043913 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCWeiner, AR, CCN 043885 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCMalvern, AR, CCN 043910 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCGreenbrier, AR, CCN 043909 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCMarshall, AR, CCN 043894 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCPerryville, AR, CCN 043898 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic Arkansas LTC LLCConcord, AR, CCN 043891 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023
Access Medical Clinic ArkansasCave City, AR, CCN 043915 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 24, 2023

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1265127591",
    "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",
            "telephone_number": "870-856-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 S ROGERS ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303743",
            "telephone_number": "479-746-7090",
            "fax_number": "479-476-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS MEDICAL CLINIC ARKANSAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-11",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, AR

Sources for this page

Verify at the official NPI Registry.