NPIMap

Organization Active NPI

St Francis House Nwa, Inc

Doing business as Community Clinic West Fork

  • Federally Qualified Health Center (FQHC)
  • West Fork, AR
National Provider Identifier
1336986785
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST FRANCIS HOUSE NWA, INC
Doing business as
Community Clinic West Fork
Practice address
245 School Ave Ste a
West Fork, AR 72774-3124
Phone
(479) 751-7417
Fax
(479) 751-4898
NPI assigned
Jul 12, 2024
Last updated
Jul 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Authorized official

Name
James A Semingson, CNPNPI 1841635596
Title
Ceo
Phone
(479) 751-7417

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

245 School Ave Ste a
West Fork, AR 72774-3124

Mailing address

614 E Emma Ave Ste 300
Springdale, AR 72764-4469
Phone (479) 751-7417

Other names 1

  • Community Clinic West Fork Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220527002133 AR Part B Supplier - Clinic/Group Practice 0042262495 Receives reassigned benefits from 52 practitioners
8 other NPIs on this enrollment
Practice locations: West Fork, AR; Siloam Springs, AR; Fayetteville, AR; Elkins, AR; Gentry, AR
O20241105000212 AR Part A Provider - Federally Qualified Health Center (FQHC) 0042262495 Practice locations: West Fork, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336986785. Details of each certification follow.

Federally qualified health center certification: CCN 041076

Legal name
ST. FRANCIS HOUSE NWA, INC.
Doing business as
COMMUNITY CLINIC WEST FORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 1, 2024
Last certification
Nov 1, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in AR
Enrollment address
245 School Ave
Ste a
West Fork, AR 72774-3124

Other NPIs on the same Medicare enrollment 8

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

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
04D2307944Community Clinic West Fork245 School Ave, Ste a, West Fork, AR 72774Certificate of waiverJul 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Family Medical Center33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Locations

3162 W Martin Luther King Jr Blvd
Ste 13
Fayetteville, AR 72704
Phone (479) 935-4834

1114 Poplar Pl
Rogers, AR 72756
Phone (479) 636-9235

1500 N Mount Olive St
#1
Siloam Springs, AR 72761
Phone (479) 524-8175

304 S Maxwell St
Siloam Springs, AR 72761
Phone (479) 524-9550

2667 Hylton Rd
Ofc 604
Springdale, AR 72764

420 N West End St
Springdale, AR 72764
Phone (479) 750-8859

610 E Emma Ave
Ste C
Springdale, AR 72764

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
St. Francis House Nwa, Inc. Organization, Springdale, AR Other Oct 1, 2024 100%
Sloan Scroggin Individual Corporate DirectorMember, Board of Directors Aug 30, 2023 8.33%
Carol Silva Moralez Individual Corporate DirectorVice-President, Board of Directors Aug 30, 2023 8.33%
Martha Anderson Individual Corporate DirectorMember, Board of Directors Aug 30, 2023 8.33%
Albert Barber Individual Corporate DirectorMember, Board of Directors Aug 30, 2023 8.33%
Debby Thetford Nye Individual Corporate DirectorSecretary, Board of Directors Aug 30, 2023 8.33%
Sara Milford Individual Corporate DirectorMember, Board of Directors Aug 30, 2023 8.33%
James a Semingson Individual W-2 Managing EmployeeCeo Sep 17, 2018 8.33%
Randolph Torres Individual Corporate DirectorMember, Board of Directors Jul 24, 2024 8.33%
Mayra P Esquivel Individual Corporate DirectorMember, Board of Directors Aug 30, 2023 8.33%
Jenny England Individual Corporate DirectorMember, Board of Directors Jul 24, 2024 8.33%
Lynn Su Chen Wong Individual Corporate DirectorMember, Board of Directors Aug 30, 2023 8.33%
Andrew Branch Individual Corporate DirectorPresident, Board of Directors Aug 30, 2023 8.33%

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 17

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

FacilityTypeRoleSince
Owl Creek School Based Health CenterFayetteville, AR, CCN 041886 Federally qualified health center Other (100%) Apr 3, 2014
Jones School Based Health CenterSpringdale, AR, CCN 041897 Federally qualified health center Other (100%) May 20, 2014
Siloam Springs School Based Health CenterSiloam Springs, AR, CCN 041896 Federally qualified health center Other (100%) Jun 26, 2014
Prairie Grove School Based Health CenterPrairie Grove, AR, CCN 041899 Federally qualified health center Other (100%) Aug 4, 2014
Community Clinic Springdale Medical Family PracticeSpringdale, AR, CCN 041900 Federally qualified health center Other (100%) Aug 26, 2014
George Elementary School Based Health CenterSpringdale, AR, CCN 041904 Federally qualified health center Other (100%) Dec 9, 2014
Elmdale School Based Health CenterSpringdale, AR, CCN 041906 Federally qualified health center Other (100%) May 12, 2015
Community Clinic Fayetteville MedicalFayetteville, AR, CCN 041909 Federally qualified health center Other (100%) Nov 2, 2015
Parson Hills School Based Health CenterSpringdale, AR, CCN 041965 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 24, 2019
Community Clinic Pea RidgePea Ridge, AR, CCN 041971 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 5, 2020
Community Clinic Don Tyson School of InnovationSpringdale, AR, CCN 041001 Federally qualified health center Operational/Managerial Control (100%) Feb 14, 2022
Community Clinic ElkinsElkins, AR, CCN 041007 Federally qualified health center Other (100%) May 1, 2022
Community Clinic CentertonCenterton, AR, CCN 041017 Federally qualified health center Other (100%) Nov 28, 2022
Community Clinic Fayetteville High SchoolFayetteville, AR, CCN 041037 Federally qualified health center Other (100%) Aug 30, 2023
Advanced Health & Wellness IFayetteville, AR, CCN 041048 Federally qualified health center Other (100%) Jan 1, 2024
Community Clinic Central Junior HighSpringdale, AR, CCN 041074 Federally qualified health center Other (100%) Jul 17, 2024
Community Clinic Rogers HeritageRogers, AR, CCN 041107 Federally qualified health center Other (100%) Apr 6, 2026

Practitioners & affiliated clinicians

Practitioners 104

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 104

NPI Registry JSON

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

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1336986785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVE STE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644469",
            "telephone_number": "479-751-7417",
            "fax_number": "479-751-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 SCHOOL AVE STE A",
            "city": "WEST FORK",
            "state": "AR",
            "postal_code": "727743124",
            "telephone_number": "479-751-7417",
            "fax_number": "479-751-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST FRANCIS HOUSE NWA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-12",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A",
        "authorized_official_last_name": "SEMINGSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-751-7417",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Clinic West Fork",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Fork, AR

Sources for this page

Verify at the official NPI Registry.