NPIMap

Organization Active NPI

Delta Memorial Hospital

  • Critical Access Hospital
  • Dumas, AR
National Provider Identifier
1295767689
Registry record updated Feb 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
AR4392 Issued in AR
Legal business name
DELTA MEMORIAL HOSPITAL
Practice address
811 Hwy 65 South
Dumas, AR 71639
Phone
(870) 382-4303
Fax
(870) 382-6555
NPI assigned
Jul 7, 2006
Last updated
Feb 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2013

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

Authorized official

Name
Cris Bolin
Title
Cfo
Phone
(870) 382-8126

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X AR4296 AR
Critical Access Hospital 282NC0060X AR4392 AR Primary

Addresses

Primary practice location

811 Hwy 65 South
Dumas, AR 71639

Mailing address

811 Hwy 65 South
Dumas, AR 71639
Phone (870) 382-4303

Other identifiers 2

IdentifierTypeStateIssuer
11326OtherARBLUE CROSS PROVIDER NUMBE
102081105MedicaidAR

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040323000890 AR Part B Supplier - Clinic/Group Practice 1658262241 Receives reassigned benefits from 19 practitioners
2 other NPIs on this enrollment
Practice locations: Dumas, AR; Warren, AR
O20061104000369 AR Part A Provider - Critical Access Hospital 1658262241 Receives reassigned benefits from 14 practitioners
Practice locations: Dumas, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295767689. Details of each certification follow.

Hospital certification: CCN 041326

Legal name
DELTA MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2005
Last certification
Sep 14, 2018
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 1975 in AR
Enrollment address
811 Highway 65 South
Dumas, AR 71639-3006
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Delta Memorial HospitalCCN 041326 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

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
John F Freeman Individual Corporate DirectorBoard Member Jun 27, 2013
Jeremy Capps Individual Corporate OfficerCeo Sep 21, 2022 100%
Corporate Director Sep 21, 2022 100%
Operational/Managerial Control Sep 21, 2022 100%
Skye Wells Individual Corporate OfficerCfo Aug 1, 2024
Operational/Managerial Control Aug 1, 2024
Robin Shea Individual Other Jul 28, 2012
Timothy Jones Individual Corporate Director Jun 25, 2009
Flora Simon Individual Corporate DirectorBoard Member Jun 27, 2013
Shirley Teeter Individual Corporate Director Dec 11, 2012

Practitioners & affiliated clinicians

Practitioners 22

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 22

Affiliated clinicians 19

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360800000000",
    "number": "1295767689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 HWY 65 SOUTH",
            "city": "DUMAS",
            "state": "AR",
            "postal_code": "71639",
            "telephone_number": "870-382-4303",
            "fax_number": "870-382-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 HWY 65 SOUTH",
            "city": "DUMAS",
            "state": "AR",
            "postal_code": "71639",
            "telephone_number": "870-382-4303",
            "fax_number": "870-382-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2013-02-14",
        "status": "A",
        "authorized_official_last_name": "BOLIN",
        "authorized_official_first_name": "CRIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-382-8126"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AR",
            "license": "AR4296",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AR",
            "license": "AR4392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "11326",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102081105",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dumas, AR

Sources for this page

Verify at the official NPI Registry.