NPIMap

Organization Active NPI

Arkansas Central Primary Care, PLLC

Doing business as Jacksonville Medical Care

  • Family Medicine Physician
  • Jacksonville, AR
National Provider Identifier
1396996740
Registry record updated Feb 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ARKANSAS CENTRAL PRIMARY CARE, PLLC
Doing business as
Jacksonville Medical Care
Practice address
1300 Braden St.
Jacksonville, AR 72076-3719
Phone
(501) 985-5900
Fax
(501) 985-6016
NPI assigned
Oct 3, 2008
Last updated
Feb 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2011

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

Authorized official

Name
Mr. Gary Drew Jackson
Title
Clinic Administrator
Phone
(501) 985-5994

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
General Practice Physician 208D00000X

Addresses

Primary practice location

1300 Braden St.
Jacksonville, AR 72076-3719

Mailing address

PO Box 309
Jacksonville, AR 72078-0309
Phone (501) 985-5900

Other identifiers 2

IdentifierTypeStateIssuer
142734002MedicaidAR
176116002MedicaidAR

Other names 1

  • Jacksonville Medical Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090127000115 AR Part B Supplier - Clinic/Group Practice 8729142682 Receives reassigned benefits from 12 practitioners
Practice locations: Jacksonville, AR
O20100930009542 AR DME Supplier - Physician - Family Practice 8729142682 Practice locations: Jacksonville, AR

Other NPIs with the same Medicare PAC ID 1

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

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
04D0466383Jacksonville Medical Care1300 Braden Street, Jacksonville, AR 72076ComplianceNov 13, 2026

National Provider Directory

National Provider Directory

Locations

2037 W Main St
Cabot, AR 72023
Phone (501) 843-4555

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296604800000",
    "number": "1396996740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 309",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720780309",
            "telephone_number": "501-985-5900",
            "fax_number": "501-985-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BRADEN ST.",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720763719",
            "telephone_number": "501-985-5900",
            "fax_number": "501-985-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS CENTRAL PRIMARY CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2011-02-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "DREW",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "501-985-5994",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142734002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176116002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville Medical Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.