NPIMap

Organization Active NPI

Baxter County Regional Hospital, Inc

Doing business as Baxter Health Family Clinic at Melbourne

  • Rural Health Clinic/Center
  • Melbourne, AR
National Provider Identifier
1336947167
Registry record updated Jul 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BAXTER COUNTY REGIONAL HOSPITAL, INC
Doing business as
Baxter Health Family Clinic at Melbourne
Practice address
1019 E Main St
Melbourne, AR 72556-8240
Phone
(870) 916-2150
Fax
(870) 916-2012
NPI assigned
Mar 6, 2025
Last updated
Jul 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2026

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

1019 E Main St
Melbourne, AR 72556-8240

Mailing address

PO Box 707
Mountain Home, AR 72654-0707
Phone (870) 424-7070

Other names 1

  • Baxter Health Family Clinic at Melbourne Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050607001085 AR Part B Supplier - Clinic/Group Practice 3274420971 Receives reassigned benefits from 32 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Calico Rock, AR; Harrison, AR; Mammoth Spring, AR; Melbourne, AR; Mountain Home, AR; Mountain View, AR; Yellville, AR
O20250403002308 AR Part A Provider - Rural Health Clinic 3274420971 Practice locations: Melbourne, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336947167. Details of each certification follow.

Rural health clinic certification: CCN 048555

Legal name
BAXTER COUNTY REGIONAL HOSPITAL INC
Doing business as
BAXTER HEALTH FAMILY CLINIC AT MELBOURNE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 15, 2025
Last certification
Sep 15, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
1019 E Main St
Melbourne, AR 72556-8240
Related CCNs
040027

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Baxter Cnty Reg Hosp Inc44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Sally Gilbert Individual Corporate DirectorBoard of Director Mar 1, 2010
Melissa B Dirst-Roberts Individual Corporate DirectorBoard of Director Jan 1, 2023
Rondell Peterson Individual Corporate OfficerCeo Jun 1, 2007
Corporate DirectorCeo Jun 1, 2007
W-2 Managing EmployeeCeo Jun 1, 2007
Debra Henry Individual Corporate OfficerCfo Jun 1, 2016
Corporate DirectorCfo Jun 1, 2016
W-2 Managing EmployeeCfo Jun 1, 2016
Baxter County Regional Hospital Inc Organization, Mountain Home, AR Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2025 100%
Heather Knight Loftis Individual Corporate DirectorBoard of Director Dec 1, 2021
Lang Zimmerman Individual Corporate DirectorBoard of Director Nov 1, 2016
Steve Luelf Individual Corporate DirectorBoard of Director Nov 1, 2005
Paul Wade Individual Corporate DirectorBoard of Director May 1, 2017
Nicole Vaccarella Individual W-2 Managing EmployeeVP General Counsel Mar 1, 2000
Ted Sanders Individual Corporate DirectorBoard of Director Jan 1, 2008
Randy Hopper Individual Corporate DirectorBoard of Director Jan 1, 2019
Matthew Baker Wilson Individual Corporate DirectorBoard of Director Jan 1, 2025
Jerry Cunningham Individual Corporate DirectorBoard of Director Oct 1, 2011

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 5

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

FacilityTypeRoleSince
Baxter HealthMountain Home, AR, CCN 040027 Hospital Operational/Managerial Control Nov 1, 1966
Baxter Health Family Clinic at Calico RockCalico Rock, AR, CCN 048559 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2025
Baxter Health Family ClinicMountain Home, AR, CCN 048558 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2025
Baxter Health Family Clinic at Mountain ViewMountain View, AR, CCN 048556 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025
Baxter Health Market Street Family ClinicMountain Home, AR, CCN 048557 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1741219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784851200000",
    "number": "1336947167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 707",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726540707",
            "telephone_number": "870-424-7070",
            "fax_number": "870-424-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 E MAIN ST",
            "city": "MELBOURNE",
            "state": "AR",
            "postal_code": "725568240",
            "telephone_number": "870-916-2150",
            "fax_number": "870-916-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAXTER COUNTY REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-06",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "870-508-1003"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baxter Health Family Clinic at Melbourne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, AR

Sources for this page

Verify at the official NPI Registry.