NPIMap

Organization Active NPI

St Bernards Physician Clinics Inc

  • Primary Care Clinic/Center
  • Jonesboro, AR
National Provider Identifier
1275204307
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ST BERNARDS PHYSICIAN CLINICS INC
Practice address
415 E Matthews Ave
Jonesboro, AR 72401-3142
Phone
(870) 972-8181
Fax
(870) 935-8749
NPI assigned
Sep 28, 2021
Last updated
Jun 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Authorized official

Name
John Lieblong
Title
President
Phone
(870) 932-7024

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

415 E Matthews Ave
Jonesboro, AR 72401-3142

Mailing address

PO Box 1331
Jonesboro, AR 72403-1331
Phone (870) 932-7024

Other practice location 1

3364 W Hwy 18
Manila, AR 72442
Phone (870) 561-3300

Other practice location 2

710 Falls Blvd S
Wynne, AR 72396-3514
Phone (870) 238-2321

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210810001875 AR Part B Supplier - Clinic/Group Practice 7012311269 Receives reassigned benefits from 256 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jonesboro, AR; Lake City, AR; Leachville, AR; Manila, AR; Manilla, AR; Marion, AR; Newport, AR; Osceola, AR…
O20230105000547 MO Part B Supplier - Clinic/Group Practice 7012311269 Receives reassigned benefits from 25 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jefferson City, MO; Kennett, MO

Other NPIs on the same Medicare enrollment 8

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

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
04D0681086St Bernards Physician Clinics, Inc415 East Matthews Avenue, Jonesboro, AR 72401ComplianceOct 24, 2027

National Provider Directory

National Provider Directory

Locations

225 E Washington Ave
Jonesboro, AR 72401
Phone (870) 207-1630

1300 Industrial Park Dr
Trumann, AR 72472
Phone (870) 412-1122

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1275204307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1331",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031331",
            "telephone_number": "870-932-7024",
            "fax_number": "870-930-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E MATTHEWS AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013142",
            "telephone_number": "870-972-8181",
            "fax_number": "870-935-8749"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3364 W Hwy 18",
            "address_purpose": "LOCATION",
            "city": "Manila",
            "state": "AR",
            "postal_code": "72442",
            "country_code": "US",
            "telephone_number": "870-561-3300",
            "fax_number": "870-561-3307",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "710 Falls Blvd S",
            "address_purpose": "LOCATION",
            "city": "Wynne",
            "state": "AR",
            "postal_code": "723963514",
            "country_code": "US",
            "telephone_number": "870-238-2321",
            "fax_number": "870-238-0114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST BERNARDS PHYSICIAN CLINICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-28",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-06",
        "status": "A",
        "authorized_official_last_name": "LIEBLONG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-932-7024"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.