NPIMap

Organization Active NPI

Baptist Memorial Hospital-Jonesboro Inc

Doing business as NEA Baptist Memorial Hospital

  • General Acute Care Hospital
  • Jonesboro, AR
National Provider Identifier
1386699353
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
4183 Issued in AR
Legal business name
BAPTIST MEMORIAL HOSPITAL-JONESBORO INC
Doing business as
NEA Baptist Memorial Hospital
Practice address
4800 E Johnson Ave
Jonesboro, AR 72401-8413
Phone
(870) 936-1000
Fax
(870) 936-0101
NPI assigned
May 24, 2006
Last updated
Sep 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Gregory Duckett
Title
SVP/ Clo
Phone
(901) 227-5233

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
General Acute Care Hospital 282N00000X 4183 AR Primary

Addresses

Primary practice location

4800 E Johnson Ave
Jonesboro, AR 72401-8413

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177

Other identifiers 1

IdentifierTypeStateIssuer
192756105MedicaidAR

Other names 1

  • NEA Baptist Memorial Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20110922000133 AR Part A Provider - Hospital 7113004821 Practice locations: Jonesboro, AR
O20180430000103 AR Part B Supplier - Intensive Cardiac Rehabilitation 7113004821 Receives reassigned benefits from 1 practitioner
Practice locations: Jonesboro, AR
O20181010003480 AR Part B Supplier - Clinic/Group Practice 7113004821 Receives reassigned benefits from 11 practitioners
Practice locations: Jonesboro, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386699353. Details of each certification follow.

Hospital certification: CCN 040118

Legal name
BAPTIST MEMORIAL HOSPITAL-JONESBORO INC
Doing business as
NEA BAPTIST MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Mar 19, 1979
Last certification
Nov 8, 2024
Beds
228
Ownership / control type
Private (not for profit)
Most recent change of ownership
Dec 1, 2003 (4 total)
Organization structure
CorporationNon-profit
Incorporated
Oct 17, 2007 in AR
Enrollment address
4800 E Johnson Ave
Jonesboro, AR 72405-8413
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Baptist Memorial Hospital Jonesboro, Inc.CCN 040118 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
04D0467983Nea Baptist Memorial Hospital4800 East Johnson, Jonesboro, AR 72401AccreditationFeb 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Baptist Memorial Hospital-Jonesboro Inc2 organizations share this tax ID, including this one
Part of
Baptist Memorial Health Care Corp

Other organizations with this tax ID 1

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

Member of 1

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

Locations

3024 Stadium Blvd
Jonesboro, AR 72404
Phone (870) 972-7000

4808 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 936-7000

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Kenneth B Jones Individual Corporate DirectorBoard Member Feb 24, 2021
Louis Schaaf Individual Corporate DirectorBoard Member Nov 9, 2020
Robert Dale Taylor Individual Corporate Director Aug 1, 2011
Jason M Little Individual Corporate Director Nov 1, 2007
Matthew Haustein Individual Corporate DirectorBoard Member Feb 24, 2021
Matthew a Quick Individual Corporate DirectorBoard Member Feb 24, 2021
Stephen O Woodruff Individual Corporate DirectorBoard Member Nov 9, 2020
Skip Steward Individual Corporate DirectorBoard Member Nov 9, 2020
Kevin B Collins Individual Corporate DirectorBoard Member/ Chief of Staff Nov 9, 2020
Arthur Maples Individual Corporate Director Dec 1, 2015
Jay Allen Individual Corporate DirectorBoard Member Nov 9, 2020
Paul Duane Depriest Individual Corporate Officer Jun 1, 2014
Samuel Lynd Individual Corporate OfficerCeo/ Administrator Nov 9, 2020
Corporate DirectorBoard Member Nov 9, 2020
Danny Ford Individual Corporate DirectorBoard Member Nov 9, 2020
Gregory M Duckett Individual Corporate OfficerCorporate Secretary/Treasurer Oct 17, 2007
Corporate Director Oct 17, 2007
Baptist Memorial Hospital-Jonesboro Inc Organization, Jonesboro, AR Corporation, Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2011 100%
Murray Benton Individual Corporate DirectorBoard Member Nov 9, 2020
Brad H Parsons Individual W-2 Managing EmployeeAdministrator Jun 11, 2012
Susan Ferguson Individual Corporate DirectorBoard Member Nov 9, 2020
Rodney Lee Clark Individual Corporate DirectorBoard Member Nov 9, 2020
William Griffin Individual Corporate OfficerEvp/ Cfo Nov 19, 2020
Corporate DirectorEvp/ Cfo Dec 1, 2015
Baptist Memorial Health Care Corporation Organization, Memphis, TN Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Oct 17, 2011 100%
Randy King Individual Corporate Director Jan 1, 2016

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Nea Baptist Memorial HospitalJonesboro, AR, CCN 04T118 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 17, 2011
Oct 17, 2011

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 47

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

View all 47

Practitioners & affiliated clinicians

Practitioners 59

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 59

Affiliated clinicians 448

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 448

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1386699353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N HUMPHREYS BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202177",
            "fax_number": "870-936-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 E JOHNSON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724018413",
            "telephone_number": "870-936-1000",
            "fax_number": "870-936-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST MEMORIAL HOSPITAL-JONESBORO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2006-05-24",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "SVP/ CLO",
        "authorized_official_telephone_number": "901-227-5233"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "AR",
            "license": "4183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192756105",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEA Baptist Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NEA Baptist Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.