NPIMap

Organization Active NPI

Jefferson Hospital Association, Inc.

Doing business as South Arkansas Orthopaedic Center

  • Orthopaedic Surgery Physician
  • Pine Bluff, AR
National Provider Identifier
1275841306
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
JEFFERSON HOSPITAL ASSOCIATION, INC.
Doing business as
South Arkansas Orthopaedic Center
Practice address
1609 W 40TH Ave
Suite 501
Pine Bluff, AR 71603-6319
Phone
(870) 534-3449
Fax
(870) 535-3973
NPI assigned
Sep 23, 2010
Last updated
Jan 25, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Authorized official

Name
Walter E Johnson
Title
President/Ceo
Phone
(870) 541-7269

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

1609 W 40TH Ave
Suite 501
Pine Bluff, AR 71603-6319

Mailing address

1609 W 40TH Ave
Suite 501
Pine Bluff, AR 71603-6319
Phone (870) 534-3449

Other names 1

  • SOUTH ARKANSAS ORTHOPAEDIC CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101112000047 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 3 practitioners
Practice locations: Pine Bluff, AR

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Jefferson Regional Specialty HospitalWhite Hall, AR, CCN 043038 Hospital 5% Or Greater Direct Ownership Interest (60%) Jun 4, 2024
Jefferson Regional Specialty HospitalWhite Hall, AR, CCN 04SD38 Hospital 5% Or Greater Direct Ownership Interest (60%) Jun 4, 2024
Jefferson HomecareWhite Hall, AR, CCN 047093 Home health agency 5% Or Greater Direct Ownership Interest (33%) Jun 1, 2008
Jefferson Regional Monticello Medical ClinicMonticello, AR, CCN 048533 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 1966
Jefferson Regional Crossett ClinicCrossett, AR, CCN 048532 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 1966

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295913600000",
    "number": "1275841306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 501",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036319",
            "telephone_number": "870-534-3449",
            "fax_number": "870-535-3973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 501",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036319",
            "telephone_number": "870-534-3449",
            "fax_number": "870-535-3973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-23",
        "last_updated": "2011-01-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "870-541-7269"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH ARKANSAS ORTHOPAEDIC CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Bluff, AR

Sources for this page

Verify at the official NPI Registry.