Jefferson Hospital Association, Inc.
Organization Active NPI Orthopaedic Surgery Physician · Pine Bluff, AR
NPI 1275841306 · NPPES record last updated Jan 25, 2011
Key facts
- NPI
- 1275841306
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- JEFFERSON HOSPITAL ASSOCIATION, INC.
- 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
- Organization subpart
- No
Authorized official
- Name
- Walter E Johnson
- Title
- President/Ceo
- Phone
- (870) 541-7269
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 8
Practitioners 80
-
Gordon Troy Birk, MD
-
Ashok Akula, M.D.,
-
Ali Al-Nashif, M.D.
-
Maher Alesali, MD
-
Meer Akbar Ali, M.D.
-
Ayman Alshami, MD
-
Maaman Bashir, M.D
-
Amy Boast Cahill, M.D.
-
Brian Campbell Jimenez, M.D.
-
Leanne Metzger Carter, PA-C
-
Michelle Eckert, MD
-
Chinedu D Ede, M.D
-
Sarenthia Monet Epps, M.D.
-
Lee A Forestiere, M. D.
-
Ricki Yvonne Fram, M.D.
-
Ian Trevor Gaillard, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Jefferson Regional Specialty Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (60%) | Jun 4, 2024 |
| Jefferson Regional Specialty Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (60%) | Jun 4, 2024 |
| Jefferson Homecare |
Home health agency | 5% Or Greater Direct Ownership Interest (33%) | Jun 1, 2008 |
| Jefferson Regional Monticello Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Sep 30, 1966 |
| Jefferson Regional Crossett Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Sep 30, 1966 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101112000047 | AR | Part B Supplier - Clinic/Group Practice | 8123927431 |
Receives reassigned benefits from 3 practitioners Practice locations: Pine Bluff, AR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5G334 | Other | AR | BCBS |
| 185009002 | Medicaid | AR |
Other names
- SOUTH ARKANSAS ORTHOPAEDIC CENTER
Other providers in Pine Bluff, AR
- Jefferson Hospital Association, Inc
- Jefferson Hospital Association, Inc
- Jefferson Hospital Association, Inc
- Jefferson Hospital Association, Inc
- Jefferson Hospital Association, Inc.
- Jefferson Hospital Association, Inc.
- Jefferson Hospital Association, Inc.
- Jefferson Hospital Association, Inc.
- Jefferson Regional Anesthesia LLC
- Jefferson Regional Cancer Center
All providers in Pine Bluff, AR · Orthopaedic Surgery Physician 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 25, 2011. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.