NPIMap

Organization Active NPI

Healthy Connections, Inc.

  • Federally Qualified Health Center (FQHC)
  • Malvern, AR
National Provider Identifier
1306568043
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTHY CONNECTIONS, INC.
Practice address
1003 Schneider Dr
Malvern, AR 72104-4811
Phone
(479) 437-3449
Fax
(479) 243-0285
NPI assigned
Sep 19, 2022
Last updated
Jan 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Authorized official

Name
Shana Bush
Title
Credentialing Specialist
Phone
(479) 437-3449

Specialties & licenses 1

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

Addresses

Primary practice location

1003 Schneider Dr
Malvern, AR 72104-4811

Mailing address

PO Box 1848
Mena, AR 71953-1841
Phone (479) 437-3449

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040106000555 AR Part B Supplier - Clinic/Group Practice 9931018421 Receives reassigned benefits from 59 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Texarkana, AR; Sheridan, AR; Russellville, AR; Mount Ida, AR; Hot Springs, AR; Mena, AR; Malvern, AR; Hot Springs Village, AR…
O20221013000979 AR Part A Provider - Federally Qualified Health Center (FQHC) 9931018421 Practice locations: Malvern, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306568043. Details of each certification follow.

Federally qualified health center certification: CCN 041012

Legal name
HEALTHY CONNECTIONS INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 5, 2022
Last certification
Oct 5, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1998 in AR
Enrollment address
1003 Schneider Dr
Malvern, AR 72104-4811

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Other NPIs on the same Medicare enrollment 19

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

View all 19

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
04D2268214Healthy Connections Pinnacle - Malvern1003 Schneider Drive, Malvern, AR 72104Certificate of waiverSep 7, 2026

National Provider Directory

National Provider Directory
Tax ID family
Healthy Connections Incorporated21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Steve Rook Individual Corporate DirectorBoard Member Dec 1, 2020
Stephen Warrick Individual Corporate DirectorBoard Member Apr 26, 2022
William a Gathright Individual Corporate DirectorSecretary Jan 1, 2008
Anthony Calandro Individual Corporate OfficerCeo Oct 4, 2010
W-2 Managing Employee Oct 4, 2010
Sherry Johnston Individual Corporate DirectorBoard Member Feb 1, 2018
Bruce Wayne Jones Individual Corporate DirectorBoard Member Dec 1, 2015
Billie Holsomback Individual Corporate DirectorBoard Member Nov 1, 2018
Kim Armstrong Individual Corporate DirectorBoard Member Jan 1, 2019
William T Edwards Individual Corporate DirectorVice-Chairman Dec 1, 2011
Dalton Hopper Individual Corporate DirectorBoard Member Apr 26, 2022
Healthy Connections Incorporated Organization, Mena, AR Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 20, 1998

Owners & managing parties with NPI records 18

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 18

All facility ownership & control disclosures 10

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

FacilityTypeRoleSince
Healthy Connections IncorporatedHot Springs, AR, CCN 041907 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 20, 1998
Healthy Connections IncorporatedArkadelphia, AR, CCN 041931 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 20, 1998
Healthy Connections IncorporatedHot Springs, AR, CCN 041957 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 20, 1998
Healthy Connections IncorporatedLittle Rock, AR, CCN 041962 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 20, 1998
Healthy Connections IncorporatedHot Springs Village, AR, CCN 041988 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 20, 1998
Healthy Connections IncorporatedRussellville, AR, CCN 041010 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 20, 1998
Healthy Connections IncorporatedHaskell, AR, CCN 041011 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 20, 1998
Healthy Connections IncorporatedConway, AR, CCN 041026 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 20, 1998
Healthy Connections IncorporatedSheridan, AR, CCN 041030 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 20, 1998
Healthy Connections IncorporatedTexarkana, AR, CCN 041079 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 20, 1998

Owned or controlled facilities with NPI records 10

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

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1663545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1306568043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1848",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719531841",
            "telephone_number": "479-437-3449",
            "fax_number": "479-243-0285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 SCHNEIDER DR",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721044811",
            "telephone_number": "479-437-3449",
            "fax_number": "479-243-0285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY CONNECTIONS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-19",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "SHANA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "479-437-3449"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malvern, AR

Sources for this page

Verify at the official NPI Registry.