NPIMap

Organization Active NPI

Baptist Health Hospitals

Doing business as Baptist Health Family Clinic DeWitt

  • Rural Health Clinic/Center
  • De Witt, AR
National Provider Identifier
1295932820
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BAPTIST HEALTH HOSPITALS
Doing business as
Baptist Health Family Clinic DeWitt
Practice address
1703 South Whitehead Drive
Dewitt, AR 72042-2911
Phone
(870) 946-0300
Fax
(870) 946-0303
NPI assigned
Jun 28, 2007
Last updated
Apr 2, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
BAPTIST HEALTH HOSPITALSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

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

Authorized official

Name
Troy Wells
Title
President
Phone
(501) 202-2080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X AR Primary

Addresses

Primary practice location

1703 South Whitehead Drive
Dewitt, AR 72042-2911

Mailing address

11001 Executive Center Drive
Suite 200
Little Rock, AR 72211-4393
Phone (501) 812-7800

Other identifiers 2

IdentifierTypeStateIssuer
136428729MedicaidAR
201481729MedicaidAR

Other names 1

  • Baptist Health Family Clinic DeWitt Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091118000727 AR Part A Provider - Rural Health Clinic 3870659246 Practice locations: Dewitt, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295932820. Details of each certification follow.

Rural health clinic certification: CCN 043492

Legal name
BAPTIST HEALTH HOSPITALS
Doing business as
BAPTIST HEALTH - FAMILY CLINIC DEWITT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 13, 2004
Last certification
Oct 2, 2018
Ownership / control type
2B
Organization structure
CorporationProprietary
Incorporated
Sep 1, 2008 in AR
Enrollment address
1703 South Whitehead Drive
Dewitt, AR 72042-2911
Related CCNs
040072

Other NPIs with the same Medicare PAC ID 8

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

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
04D1028354Baptist Health - Family Clinic Dewitt1703 South Whitehead Drive, De Witt, AR 72042Certificate of waiverDec 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Baptist Health Hospitals7 organizations share this tax ID, including this one
Part of
Baptist Health Hospitals

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Larry White Individual Corporate Director Jan 1, 2026
Baptist Health Organization, Little Rock, AR Non-profit Operational/Managerial Control Jan 1, 2009
Ronald Dedman Individual Corporate Director Jan 1, 2026
Lamarr Bailey Individual Corporate Director Jan 1, 2026
Herren Hickingbotham Individual Corporate Director Jan 1, 2026
Judy Simmons Henry Individual Corporate Director Jan 1, 2026
Michael Akin Individual Corporate Director Jan 1, 2026
Chris Brune Individual Corporate Director Jan 1, 2026
Troy Wells Individual Corporate Director Jan 1, 2009
W-2 Managing Employee Jul 1, 2014
Suzanne Peyton Individual Corporate Director Jan 1, 2026
John McMorran Individual Corporate Director Jan 1, 2026
Steven D Weeks Individual Corporate Director Jan 1, 2009
Lindsey Lorence Individual Corporate Director Jan 1, 2026
Steven Booth Individual Corporate Director Jan 1, 2026
David Mitchell Individual Corporate Director Jan 1, 2026
James S Jones Individual Corporate Director Jan 1, 2026
Louis M Lee Individual Corporate Director Jan 1, 2026
Teresa Howell Individual Corporate Director Jan 1, 2026
Brent Beaulieu Individual Corporate Officer Jan 18, 2018
W-2 Managing Employee Jan 18, 2018
Glenn Millner Individual Corporate Director Jan 1, 2026
Les Warren Individual Corporate Director Jan 1, 2026

Facilities with the same owner 50

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Baptist Health

    dba Baptist Health Family Clinic Greers Ferry

    • Rural Health Clinic/Center
    • Greers Ferry, AR
    • NPI 1003821703

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Home Health Network

    • Home Health Agency
    • Heber Springs, AR
    • NPI 1033213632

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Health Medical Center-Little Rock

    • General Acute Care Hospital
    • Little Rock, AR
    • NPI 1043240682

    Baptist Health

    CMS ownership
  • Baptist Health
    • Rural Health Clinic/Center
    • Heber Springs, AR
    • NPI 1104268689

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Health Family Clinic - Sheridan

    • Rural Health Clinic/Center
    • Sheridan, AR
    • NPI 1114792157

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Home Health Network

    • Home Health Agency
    • Little Rock, AR
    • NPI 1134225451

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Hospice

    • Community Based Hospice Care Agency
    • Little Rock, AR
    • NPI 1164526554

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Health Medical Center-Arkadelphia

    • Critical Access Hospital
    • Arkadelphia, AR
    • NPI 1174553796

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Health Rehabilitation Institute

    • Rehabilitation Hospital
    • Little Rock, AR
    • NPI 1215967831

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Medical Center-Psych

    • Psychiatric Hospital Unit
    • Little Rock, AR
    • NPI 1255377420

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Health Ouachita Valley Family Clinic

    • Rural Health Clinic/Center
    • Camden, AR
    • NPI 1366279424

    Baptist Health

    CMS ownership
  • Baptist Health

    dba Baptist Health Family Clinic - Beebe

    • Rural Health Clinic/Center
    • Beebe, AR
    • NPI 1376336883

    Baptist Health

    CMS ownership
View all 50

NPI Registry JSON

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743552000000",
    "number": "1295932820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DRIVE",
            "address_2": "SUITE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114393",
            "telephone_number": "501-812-7800",
            "fax_number": "501-812-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 SOUTH WHITEHEAD DRIVE",
            "city": "DEWITT",
            "state": "AR",
            "postal_code": "720422911",
            "telephone_number": "870-946-0300",
            "fax_number": "870-946-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST HEALTH HOSPITALS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST HEALTH HOSPITALS",
        "enumeration_date": "2007-06-28",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-202-2080"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136428729",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201481729",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Health Family Clinic DeWitt",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Witt, AR

Sources for this page

Verify at the official NPI Registry.