NPIMap

Organization Active NPI

Mainline Health Systems, Inc

  • Specialist
  • Portland, AR
National Provider Identifier
1407650179
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MAINLINE HEALTH SYSTEMS, INC
Practice address
233 N Main St
Portland, AR 71663-9230
Phone
(870) 737-2221
Fax
(855) 878-5991
NPI assigned
Apr 2, 2025
Last updated
May 18, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Authorized official

Name
Gary Allan Nichols
Title
Ceo
Phone
(870) 942-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

233 N Main St
Portland, AR 71663-9230

Mailing address

342 Highway 425 S
Monticello, AR 71655-4612
Phone (870) 942-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041011000567 AR Part B Supplier - Clinic/Group Practice 5193785590 Receives reassigned benefits from 62 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, AR; Rison, AR; Sheridan, AR; Star City, AR; Star City,, AR; Warren, AR; Wilmot, AR; Eudora, AR…

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Sanyasi R Ganta MD35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Practitioners & affiliated clinicians

Practitioners 1

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": "1743552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1407650179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 HIGHWAY 425 S",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716554612",
            "telephone_number": "870-942-3000",
            "fax_number": "870-942-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 N MAIN ST",
            "city": "PORTLAND",
            "state": "AR",
            "postal_code": "716639230",
            "telephone_number": "870-737-2221",
            "fax_number": "855-878-5991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-02",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-942-3000"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.