NPIMap

Organization Active NPI

Mississippi County Hospital System

  • Anesthesiology Physician
  • Blytheville, AR
National Provider Identifier
1376844878
Registry record updated Apr 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
999999 Issued in AR
Legal business name
MISSISSIPPI COUNTY HOSPITAL SYSTEM
Practice address
1520 N Division St
Anesthesia Department
Blytheville, AR 72315-1448
Phone
(870) 838-7300
NPI assigned
Nov 15, 2010
Last updated
Apr 29, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2011

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

Authorized official

Name
Steve E McGuire
Title
County Judge
Phone
(870) 838-7463

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X 999999 AR Primary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X 999999 AR
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X 999999 AR
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X 999999 AR
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X 999999 AR

Addresses

Primary practice location

1520 N Division St
Anesthesia Department
Blytheville, AR 72315-1448

Mailing address

PO Box 167
Blytheville, AR 72316-0167
Phone (870) 838-7445

Other identifiers 3

IdentifierTypeStateIssuer
185918002MedicaidAR
185919002MedicaidAR
5B014OtherARBLUECROSS BLUESHIELD OF ARKANSAS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110125000938 AR Part B Supplier - Clinic/Group Practice 9739230723 Receives reassigned benefits from 10 practitioners
Practice locations: Blytheville, AR; Osceola, AR

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Mississippi County Primary Care Physicians9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

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
Great River Family ClinicBlytheville, AR, CCN 048527 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2016
Mississippi County Primary Care Physicians ClinicOsceola, AR, CCN 048525 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2016

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 10

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": "1289779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304035200000",
    "number": "1376844878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 167",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723160167",
            "telephone_number": "870-838-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N DIVISION ST",
            "address_2": "ANESTHESIA DEPARTMENT",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151448",
            "telephone_number": "870-838-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI COUNTY HOSPITAL SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-15",
        "last_updated": "2011-04-29",
        "status": "A",
        "authorized_official_last_name": "MCGUIRE",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "COUNTY JUDGE",
        "authorized_official_telephone_number": "870-838-7463"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "999999",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AR",
            "license": "999999",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "AR",
            "license": "999999",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "AR",
            "license": "999999",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "999999",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185918002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185919002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD OF ARKANSAS",
            "identifier": "5B014",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blytheville, AR

Sources for this page

Verify at the official NPI Registry.