NPIMap

Organization Active NPI

Jefferson Hospital Association, Inc.

Doing business as Endocrinology of South Arkansas

  • Clinic/Center
  • White Hall, AR
National Provider Identifier
1306097365
Registry record updated Jan 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
JEFFERSON HOSPITAL ASSOCIATION, INC.
Doing business as
Endocrinology of South Arkansas
Practice address
7500 Dollarway Rd
Suite 404
White Hall, AR 71602-3027
Phone
(870) 879-9595
Fax
(870) 879-9599
NPI assigned
Oct 8, 2008
Last updated
Jan 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2011

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

7500 Dollarway Rd
Suite 404
White Hall, AR 71602-3027

Mailing address

7500 Dollarway Rd
Suite 404
White Hall, AR 71602-3027
Phone (870) 879-9595

Other identifiers 2

IdentifierTypeStateIssuer
5G130OtherARBLUE CROSS BLUE SHIELD
176263002MedicaidAR

Other names 1

  • ENDOCRINOLOGY OF SOUTH ARKANSAS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090106000067 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 1 practitioner
Practice locations: White Hall, AR

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
04D0997860Endocrinology of South Arkansas7500 Dollarway Rd, Suite 404, White Hall, AR 71602Certificate of waiverMar 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Hospital Assn Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

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 1

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": "1223424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295568000000",
    "number": "1306097365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 DOLLARWAY RD",
            "address_2": "SUITE 404",
            "city": "WHITE HALL",
            "state": "AR",
            "postal_code": "716023027",
            "telephone_number": "870-879-9595",
            "fax_number": "870-879-9599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 DOLLARWAY RD",
            "address_2": "SUITE 404",
            "city": "WHITE HALL",
            "state": "AR",
            "postal_code": "716023027",
            "telephone_number": "870-879-9595",
            "fax_number": "870-879-9599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-08",
        "last_updated": "2011-01-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-541-7269"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5G130",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176263002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ENDOCRINOLOGY OF SOUTH ARKANSAS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Hall, AR

Sources for this page

Verify at the official NPI Registry.