NPIMap

Organization Active NPI

Baxter County Regional Hospital, Inc

Doing business as Baxter Health College Street Family Clinic

  • Family Medicine Physician
  • Mountain Home, AR
National Provider Identifier
1316777329
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BAXTER COUNTY REGIONAL HOSPITAL, INC
Doing business as
Baxter Health College Street Family Clinic
Practice address
400 S College St Ste 5
Mountain Home, AR 72653-3923
Phone
(870) 508-1000
NPI assigned
Aug 5, 2024
Last updated
Aug 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Debra Henry
Title
Cfo
Phone
(870) 508-1003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

400 S College St Ste 5
Mountain Home, AR 72653-3923

Mailing address

400 S College St Ste 5
Mountain Home, AR 72653-3923
Phone (870) 508-1000

Other names 1

  • Baxter Health College Street Family Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120326000509 AR Part B Supplier - Clinic/Group Practice 0042389264 Receives reassigned benefits from 9 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mountain Home, AR

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

49 Highway 62 412
#B
Ash Flat, AR 72513
Phone (870) 508-6020

49 Highway 62 412
#E
Ash Flat, AR 72513
Phone (870) 508-3200

4196 Highway 62 412
#B
Hardy, AR 72542
Phone (870) 860-2030

1420 Highway 62 65 N
Ste 1
Harrison, AR 72601
Phone (870) 741-3600

1420 Highway 62 65 N
Ste 3
Harrison, AR 72601
Phone (870) 508-6020

1420 Highway 62 65 N
Ste 4
Harrison, AR 72601
Phone (870) 508-7080

306 N Chestnut St
#783
Harrison, AR 72601
Phone (870) 508-3200

306 N Chestnut St
#787
Harrison, AR 72601
Phone (870) 508-7080

2178 Highway 62 412
Ste A
Highland, AR 72542
Phone (870) 424-4710

1019 E Main St
#B
Melbourne, AR 72556
Phone (870) 916-2040

1019 E Main St
Ste D
Melbourne, AR 72556
Phone (870) 508-6020

230 Highway 5 N
Ste 20A
Mountain Home, AR 72653
Phone (870) 425-1787

310 Buttercup Dr
Ste C
Mountain Home, AR 72653
Phone (870) 424-7072

400 S College St
Ste 5
Mountain Home, AR 72653
Phone (870) 508-6790

444 Hospital Dr
Mountain Home, AR 72653
Phone (870) 425-7788

624 Hospital Dr
#3600
Mountain Home, AR 72653

65 Wal Mart Dr
Mountain Home, AR 72653
Phone (870) 492-2200

66 Wal Mart Dr
The Clinic at Walmart Operated by B
Mountain Home, AR 72653
Phone (870) 492-2200

103 Mountain Place Dr
Ste B
Mountain View, AR 72560
Phone (870) 269-5215

103 Mountain Place Dr
Ste C
Mountain View, AR 72560
Phone (870) 269-3447

103 Mountain Place Dr
Ste E
Mountain View, AR 72560
Phone (870) 425-8288

673 N Main St
#C
Salem, AR 72576
Phone (870) 424-4710

1402 N Kentucky Ave
Ste 2
West Plains, MO 65775
Phone (870) 508-7080

Practitioners & affiliated clinicians

Practitioners 147

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 147

NPI Registry JSON

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

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1316777329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S COLLEGE ST STE 5",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726533923",
            "telephone_number": "870-508-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S COLLEGE ST STE 5",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726533923",
            "telephone_number": "870-508-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAXTER COUNTY REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-508-1003"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baxter Health College Street Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.