NPIMap

Organization Active NPI

Boston Mountain Rural Health Center, Inc

Doing business as Bmrhc Shirley Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Shirley, AR
National Provider Identifier
1285464610
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Doing business as
Bmrhc Shirley Wellness Center
Practice address
199 School Dr
Shirley, AR 72153-7566
Phone
(870) 448-5733
NPI assigned
Aug 1, 2024
Last updated
Sep 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Authorized official

Name
Debbie Ackerson
Title
Ceo
Phone
(870) 448-5733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

199 School Dr
Shirley, AR 72153-7566

Mailing address

PO Box 1060
Marshall, AR 72650-1060
Phone (870) 448-5733

Other names 1

  • BMRHC SHIRLEY WELLNESS CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241231000268 AR Part A Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Shirley, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285464610. Details of each certification follow.

Federally qualified health center certification: CCN 041078

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Doing business as
BMRHC SHIRLEY WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 30, 2024
Last certification
Dec 30, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 1997 in AR
Enrollment address
199 School Dr
Shirley, AR 72153-7566

Other NPIs with the same Medicare PAC ID 19

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

View all 19

National Provider Directory

National Provider Directory
Tax ID family
Boston Mountain Rural H25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Locations

199 School Dr
Shirley, AR 72153
Phone (501) 723-4400

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Debbie Ackerson Individual Corporate DirectorCeo Jun 2, 2017
Christopher Graham Individual Corporate DirectorBoard Member Jan 1, 1999
Debbie Holt Individual Corporate DirectorBoard Member Jan 2, 2018
Donna Samples Individual Corporate DirectorBoard Member Jan 1, 2023
Rebecca Blair Individual Corporate OfficerCfo Dec 16, 2013
W-2 Managing EmployeeCfo Apr 13, 2018

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Boston Mountain Rural Health Center, IncMarshall, AR, CCN 041984 Federally qualified health center Other Mar 14, 1994

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1722470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1285464610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1060",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "726501060",
            "telephone_number": "870-448-5733",
            "fax_number": "870-448-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 SCHOOL DR",
            "city": "SHIRLEY",
            "state": "AR",
            "postal_code": "721537566",
            "telephone_number": "870-448-5733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MOUNTAIN RURAL HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-01",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "ACKERSON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-448-5733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMRHC SHIRLEY WELLNESS CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shirley, AR

Sources for this page

Verify at the official NPI Registry.