NPIMap

Organization Active NPI

St Johns Clinic Inc

Doing business as SJC-Berryville Family Practice

  • Family Medicine Physician
  • Berryville, AR
National Provider Identifier
1447323399
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C4889 Issued in AR
Legal business name
ST JOHNS CLINIC INC
Doing business as
SJC-Berryville Family Practice
Practice address
613 Orchard Dr
Berryville, AR 72616-5013
Phone
(870) 423-7171
Fax
(870) 423-1032
NPI assigned
Nov 16, 2006
Last updated
Jun 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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

Authorized official

Name
Vickie Jenkins
Title
Provider Enrollment Coordinator
Phone
(417) 829-4264

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C4889 AR Primary

Addresses

Primary practice location

613 Orchard Dr
Berryville, AR 72616-5013

Mailing address

PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620

Other identifiers 2

IdentifierTypeStateIssuer
150959002MedicaidAR
CR0464OtherARTRAVELERS/RR MEDICARE #

Other names 1

  • SJC-BERRYVILLE FAMILY PRACTICE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SPFD CL Cancer and Hema55 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 8

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

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": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1447323399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2580",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658012580",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 ORCHARD DR",
            "city": "BERRYVILLE",
            "state": "AR",
            "postal_code": "726165013",
            "telephone_number": "870-423-7171",
            "fax_number": "870-423-1032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHNS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "417-829-4264"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C4889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150959002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS/RR MEDICARE #",
            "identifier": "CR0464",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SJC-BERRYVILLE FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berryville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.