NPIMap

Organization Active NPI

Johnson Regional Medical Center

Doing business as JRMC Provider Based Physicians

  • Emergency Medicine Physician
  • Clarksville, AR
National Provider Identifier
1336198555
Registry record updated Feb 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
JOHNSON REGIONAL MEDICAL CENTER
Doing business as
JRMC Provider Based Physicians
Practice address
1100 E Poplar St
Clarksville, AR 72830-4419
Phone
(479) 754-5454
Fax
(479) 754-5311
NPI assigned
May 6, 2006
Last updated
Feb 4, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2009

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

Authorized official

Name
Mr. Robert Larry Morse
Title
Administrator
Phone
(479) 754-5454

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

1100 E Poplar St
Clarksville, AR 72830-4419

Mailing address

PO Box 738
Clarksville, AR 72830-0738
Phone (479) 754-5454

Other identifiers 2

IdentifierTypeStateIssuer
57977OtherARARKANSAS BLUE CROSS
128372002MedicaidAR

Other names 1

  • JRMC Provider Based Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623000733 AR Part B Supplier - Clinic/Group Practice 1658360284 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Clarksville, AR

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
JRMC Emergency Room10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

1100 E Poplar St
Ste C
Clarksville, AR 72830
Phone (479) 754-5454

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Johnson Regional Medical CenterClarksville, AR, CCN 040002 Hospital Operational/Managerial Control Jan 4, 2012
JRMC Senior Care UnitClarksville, AR, CCN 04S002 Hospital 5% Or Greater Direct Ownership Interest Jun 4, 2002

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1146873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233705600000",
    "number": "1336198555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 738",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728300738",
            "telephone_number": "479-754-5454",
            "fax_number": "479-754-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E POPLAR ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304419",
            "telephone_number": "479-754-5454",
            "fax_number": "479-754-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-06",
        "last_updated": "2009-02-04",
        "status": "A",
        "authorized_official_last_name": "MORSE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LARRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "479-754-5454",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS BLUE CROSS",
            "identifier": "57977",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128372002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JRMC Provider Based Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, AR

Sources for this page

Verify at the official NPI Registry.