NPIMap

Organization Active NPI

Baxter County Regional Hospital, Inc

Doing business as Baxter Health Fairlamb Senior Clinic

  • Clinic/Center
  • Mountain Home, AR
National Provider Identifier
1437423472
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
BAXTER COUNTY REGIONAL HOSPITAL, INC
Doing business as
Baxter Health Fairlamb Senior Clinic
Baxter Health Reppell Diabetes Clinic
Practice address
614 Broadmoor Dr
Mountain Home, AR 72653-2903
Phone
(870) 508-3870
NPI assigned
Mar 7, 2012
Last updated
Jul 17, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BAXTER COUNTY REGIONAL HOSPITAL,INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Authorized official

Name
Debra Henry
Title
Cfo
Phone
(870) 508-1003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X AR Primary

Addresses

Primary practice location

614 Broadmoor Dr
Mountain Home, AR 72653-2903

Mailing address

614 Broadmoor Dr
Mountain Home, AR 72653-2903
Phone (870) 508-3870

Other practice location 1

622 Broadmoor Dr
Mountain Home, AR 72653-2903
Phone (870) 508-1765

Other names 2

  • Baxter Health Fairlamb Senior Clinic Doing business as
  • Baxter Health Reppell Diabetes Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120525000458 AR Part B Supplier - Clinic/Group Practice 3274420971 Receives reassigned benefits from 3 practitioners
Practice locations: Mountain Home, AR

Other NPIs with the same Medicare PAC ID 16

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

View all 16

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
04D2340320Fairlamb Senior Health Clinic614 Broadmoor Dr, Mountain Home, AR 72653Certificate of waiverMar 15, 2028

National Provider Directory

National Provider Directory
Part of
Baxter Cnty Reg Hosp Inc

Ownership & related parties

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Baxter HealthMountain Home, AR, CCN 040027 Hospital Operational/Managerial Control Nov 1, 1966
Baxter Health Family Clinic at Calico RockCalico Rock, AR, CCN 048559 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2025
Baxter Health Family ClinicMountain Home, AR, CCN 048558 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2025
Baxter Health Family Clinic at MelbourneMelbourne, AR, CCN 048555 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025
Baxter Health Family Clinic at Mountain ViewMountain View, AR, CCN 048556 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025
Baxter Health Market Street Family ClinicMountain Home, AR, CCN 048557 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025

Owned or controlled facilities with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1437423472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 BROADMOOR DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532903",
            "telephone_number": "870-508-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 BROADMOOR DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532903",
            "telephone_number": "870-508-3870"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "622 Broadmoor Dr",
            "address_purpose": "LOCATION",
            "city": "Mountain Home",
            "state": "AR",
            "postal_code": "726532903",
            "country_code": "US",
            "telephone_number": "870-508-1765",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BAXTER COUNTY REGIONAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAXTER COUNTY REGIONAL HOSPITAL,INC",
        "enumeration_date": "2012-03-07",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-508-1003"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baxter Health Fairlamb Senior Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baxter Health Reppell Diabetes Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, AR

Sources for this page

Verify at the official NPI Registry.